DESIGN AND DEVELOPMENT OF A PEDIATRIC WHEELCHAIR

WITH TILT-IN-SPACE SEATING

by

Emily Zipfel

BFA in Industrial Design, Carnegie Mellon University, 2001

Submitted to the Graduate Faculty of

The School of Health and Rehabilitation Sciences in partial fulfillment

of the requirements for the degree of

Masters of Science degree in Rehabilitation Science and Technology

University of Pittsburgh

2007

i
 UNIVERSITY OF PITTSBURGH

SCHOOL OF HEALTH AND REHABILITATION SCIENCES

This thesis was presented

by

Emily Zipfel

It was defended on

July 5, 2007

and approved by

Rosemarie Cooper, MPT, Assistant Professor, Department of Rehabilitation Science and

Technology, University of Pittsburgh, Director, Center for Assistive Technology

David Boninger, PhD, 3Rivers Holdings, LLC

Thesis Director: Rory A Cooper, PhD, FISA Foundation, Paralyzed Veterans of America,

Chair and Distinguished Professor, Department of Rehabilitation Science and Technology,

University of Pittsburgh

ii
University of Pittsburgh

2007

iii
 DESIGN AND DEVELOPMENT OF A PEDIATRIC WHEELCHAIR

WITH TILT-IN-SPACE SEATING

Emily Zipfel, M.S.

University of Pittsburgh, 2007

The Pediatric Adjustable Lightweight Modular (PALM) wheelchair project consisted of

three design iterations, full-scale working prototypes, durability testing and user evaluation, and
technology transfer activities. User input was crucial to developing design requirements. A
handful of concepts developed for this design are novel in the wheelchair market and potentially
beneficial to pediatric wheelchair users and their caregivers. Some of the concepts could be
applied to other wheelchair designs in the future, including adult tilt-in-space wheelchairs and
seating for both adults and children.
The PALM’s primary construction consists of modular plastic injection molded
components and straight tubes. This feature allows it to be easily customized on site by a
therapist who can swap components and make adjustments. The modular design also allows it to
be packed more compactly thereby decreasing manufacturing and shipping costs. Second, the
tilt-in-space mechanism utilizes a unique four-bar linkage design that decreases the need for
small moving parts such as rollers and spring loaded mechanisms used in other tilt-in-space
center-of-gravity chairs. Third, the PALM’s modular design allows for greater flexibility in the
configuration of the wheelchair and adaptation to different-sized bodies. Fourth, the PALM is
highly adjustable and selectable: The seat depth, seat width, back rest height, back rest angle, leg
rest angle, footrest angle, seat-to-floor height, and axle position are all adjustable. Finally, the
PALM converts from an attendant-style wheelchair to a self-propelled wheelchair. These
features create a variety of characteristics that clearly distinguish the PALM from other currently
available pediatric wheelchairs.

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 TABLE OF CONTENTS

PREFACE.................................................................................................................................. XII
1.0 BACKGROUND .......................................................................................................... 1
1.1 WORLDWIDE NEED FOR PEDIATRIC WHEELCHAIRS ........................ 2
1.2 EXISTING PEDIATRIC WHEELCHAIRS..................................................... 4
1.3 UNIQUE NEEDS OF PEDIATRIC WHEELCHAIR USERS........................ 6
1.3.1 Physical growth and change......................................................................... 6
1.3.2 Mobility.......................................................................................................... 7
1.3.3 Self-sufficiency of child................................................................................. 8
1.3.4 Comfort and enjoyment ............................................................................... 9
1.3.5 Seating............................................................................................................ 9
1.3.6 Transportation of wheelchair and child ................................................... 11
1.3.7 Consequences of inadequate pediatric wheelchairs................................. 11
2.0 STATEMENT OF PROBLEM................................................................................. 13
3.0 AIMS ........................................................................................................................... 14
4.0 WORK PLAN............................................................................................................. 15
4.1 DESIGN PROCESS........................................................................................... 17
5.0 INDIA PHASE............................................................................................................ 23
5.1 ANTHROPOMETRY ....................................................................................... 23
5.2 INDIA PHASE DESIGN................................................................................... 25
5.2.1 Design criteria ............................................................................................. 25
5.2.2 Innovative concepts..................................................................................... 26
5.2.2.1 Modular construction......................................................................... 26
5.2.2.2 Tilt-in-space mechanism .................................................................... 28
5.2.3 Concept development.................................................................................. 29

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 5.3 INDIA PHASE CONCLUSION ....................................................................... 30
6.0 U.S. PHASE ................................................................................................................ 31
6.1 U.S. PHASE DESIGN........................................................................................ 31
6.2 FOCUS GROUP EVALUATION .................................................................... 34
6.2.1 Focus group methods.................................................................................. 35
6.2.2 Results .......................................................................................................... 36
6.3 TESTING............................................................................................................ 39
6.3.1 Method ......................................................................................................... 39
6.3.2 Results .......................................................................................................... 41
6.3.2.1 Weight and dimensions ...................................................................... 42
6.3.2.2 Comparison to test data for other wheelchairs................................ 42
6.4 U.S. PHASE CONCLUSION............................................................................ 43
7.0 FINAL DESIGN AND DEVELOPMENT PHASE................................................. 44
7.1 FINAL PHASE DESIGN .................................................................................. 44
7.1.1 Final Phase design objectives..................................................................... 45
7.1.2 Design improvements.................................................................................. 45
7.1.2.1 Objective 1: Improve ease of folding mechanism ............................ 46
7.1.2.2 Objective 2: Reduce weight................................................................ 50
7.1.2.3 Objective 3: Improve ease of use....................................................... 50
7.1.2.4 Objective 4: Improve comfort ........................................................... 53
7.1.2.5 Objective 5: Improve seating system ................................................ 54
7.1.2.6 Objective 5: Improve aesthetics ....................................................... 57
8.0 FINAL PHASE FOCUS GROUP ............................................................................. 59
9.0 NEXT STEPS ............................................................................................................. 64
9.1 DESIGN CHANGES FOR BETA PROTOTYPE .......................................... 64
9.1.1 Critical changes........................................................................................... 64
9.1.2 Less-critical changes ................................................................................... 66
9.2 TESTING FOR BETA PROTOTYPE ............................................................ 67
9.3 USER TRIALS................................................................................................... 68
9.4 STEPS FOR PRE-PRODUCTION PROTOTYPE ........................................ 68
9.5 FUTURE DESIGNS .......................................................................................... 69

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10.0 DISCUSSION ............................................................................................................. 70
APPENDIX A. FOCUS GROUP QUESTIONNAIRES.......................................................... 72
APPENDIX B. FOCUS GROUP TRANSCRIPT .................................................................... 95
APPENDIX C. CAD DRAWINGS.......................................................................................... 110
REFERENCES.......................................................................................................................... 199

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 LIST OF TABLES

Table 1: Examples of currently available pediatric wheelchairs .................................................... 6

Table 2: Anthropometric data used to determine PALM range of adjustability. 39 ...................... 24

Table 3: Problems with India PALM and resolution in US PALM.............................................. 33

Table 4: End-users' evaluations of the US PALM ........................................................................ 37

Table 5: End-users' comments about the US PALM (N=13) ....................................................... 38

Table 6: ANSI/RESNA tests performed ....................................................................................... 41

Table 7: Dimensions of US PALM prototype .............................................................................. 42

Table 8: Final PALM dimensions................................................................................................. 50

Table 9: End-users’ evaluations of the final PALM ..................................................................... 61

Table 10: End-users' comments about the PALM Phase II v3 (N=9) .......................................... 62

Table 11: Comparison between average close-ended responses from US PALM and Final PALM
..................................................................................................................................... 63

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 LIST OF FIGURES

Figure 1: Tilting seat posteriorly without shifting seat forward results in the center of gravity
moving up and back. ..................................................................................................... 4

Figure 2: Iterations of the design: Phase 1 (India PALM) Phase 2 (U.S. PALM)........................ 14

Figure 3: Flow chart describing work process.............................................................................. 16

Figure 4: CAD model.................................................................................................................... 17

Figure 5: SLA concept model ....................................................................................................... 17

Figure 6: Hand sketches from early concept stage to final stage.................................................. 18

Figure 7: US PALM...................................................................................................................... 18

Figure 8: India PALM................................................................................................................... 18

Figure 9: Final PALM................................................................................................................... 19

Figure 10: Final PALM backrest and half scale experimental model made using SLA............... 20

Figure 11: CNC manufacturing, cut part prior to bending and final product after finishing and
powder coating............................................................................................................ 20

Figure 12: Images of SLA process. Vat in which parts are made, Unpainted SLA parts and SLA
parts finished and assembled on final prototype......................................................... 21

Figure 13: Hand concept sketches of rear plastic joints and backrest .......................................... 21

Figure 14: Illustration showing the range of growth adjustability built into the wheelchair based
on anthropometric data ............................................................................................... 24

Figure 15: India PALM prototype ................................................................................................ 27

Figure 16: Side view of India PALM in tilted position. Lines indicate position of four bars in
linkage......................................................................................................................... 28

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Figure 17: Side view of U.S. PALM. Improvements to linkage geometry were made between
versions. ...................................................................................................................... 28

Figure 18: Process sketch of tilt mechanism................................................................................ 29

Figure 19: Initial concept drawings made prior to PALM P1 construction.................................. 30

Figure 20: US PALM prototype ................................................................................................... 31

Figure 21: Side view of US PALM showing points of adjustability ............................................ 34

Figure 22: Sample close-ended question ...................................................................................... 36

Figure 23: Static stability test of PALM v2 .................................................................................. 39

Figure 24: US PALM on double drum test machine .................................................................... 40

Figure 25: Concept drawing for final PALM ............................................................................... 45

Figure 26: SLA plastic components, final PALM phase .............................................................. 46

Figure 27: Machined Delrin plastic components, US PALM phase............................................ 46

Figure 28: Process of dismantling Final PALM for transport ...................................................... 47

Figure 29: Concept drawing of removable seat ............................................................................ 47

Figure 30: Close-ups of clamp releasing seat assembly ............................................................... 48

Figure 31: Image showing seat pushed forward to release tubes from locking plugs. ................. 49

Figure 32: Upholstery adheres to seat frame with Velcro, is removable and washable. .............. 52

Figure 33: Images of backrest with upholstery............................................................................. 52

Figure 34: Adjustable handle angle .............................................................................................. 53

Figure 35: Ergonomic knob design............................................................................................... 53

Figure 36: Seat moving through range of tilt and recline ............................................................. 54

Figure 37: CAD concept model of tilting seat .............................................................................. 54

Figure 38: Images of backrest showing smallest, medium and largest configuration. ................. 55

Figure 39: Images of seating components with and without upholstery ...................................... 55

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Figure 40: Close-up of adjustment mechanism used at back rest recline and leg rest angle points.
..................................................................................................................................... 56

Figure 41: Back reclined............................................................................................................... 57

Figure 42: Side view of final PALM with upholstery removed to show underlying structure.
Illustrates points of adjustability................................................................................. 57

Figure 43: Final PALM prototype ................................................................................................ 58

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 PREFACE

The PALM (Pediatric Adjustable Lightweight Manual) wheelchair project was conceptualized as
part of a larger project, the “India Wheelchair Project,” intended to improve the quality of
wheelchairs available in India. 1,2 That project consisted of three parts; the design and technology
transfer of an adult manual wheelchair, a power wheelchair, and a manual pediatric wheelchair.
The India wheelchair work was funded collaboratively by the United States government via
NIDRR (National Institute on Disability and Rehabilitation Research), the National Science
Foundation (NSF) and the Indian government. The work was a collaborative effort between the
Human Engineering Research Laboratories (HERL is a joint wheelchair research lab between the
University of Pittsburgh and the Veterans Affairs Healthcare System) and ALIMCO (the
Artificial Limbs Manufacturing Corporation of India, a government funded manufacturer of
assistive devices). The first phase of the India project, the adult manual wheelchair, was
developed and transferred to ALIMCO with some degree of success. However, through the
process of developing the pediatric wheelchair, the project took a slightly different turn.
While designing the pediatric wheelchair for India, the design team came up with a
handful of unique ideas that could potentially benefit users in India as well as in a developed
country such as the U.S. One year into the pediatric wheelchair development, funding and
commitment in both countries waned and it became necessary to seek additional funds. At this
point the team sought SBIR (Small Business Innovation Research) funding from NIDRR to
develop the pediatric wheelchair design into a product for the U.S. market. While the original
concept of a wheelchair for developing countries was not abandoned, that focus of the project
was temporarily put on hold.
The work described in this thesis first covers the need for pediatric wheelchairs
worldwide and the complex needs of pediatric wheelchair users and their caregivers. The thesis
chronologically follows the development of three wheelchair prototypes, from design work done

xii
specifically for the Indian context through final revisions done for a U.S. company, Three Rivers
Holdings, LLC. This paper ends at the final development stage before the design reached the pre-
production stage.
I would like to acknowledge the help I received over the course of this project from all
staff, students and faculty at the Human Engineering Research Laboratories, especially, Dr. Rory
Cooper, Mark McCartney, Jeremy Puhlman and Jonathan Pearlman. Other key participants to
this project’s success were David Boninger and Chris Willems at Three Rivers Holdings, with
whom two SBIR grants were written to fund this endeavor. I would also like to thank the UPMC
Center for Assistive Technology who allowed us to use the clinic space for focus groups. I
gratefully acknowledge the participation of the subjects; children, parents, and clinicians who
shared their creativity and enthusiasm with the project team. Lastly, this project would not have
been possible without funding from NIDRR, NSF and the Department of Veterans Affairs.

xiii
 1.0 BACKGROUND

The main drivers for the design were; feedback from the end-users, analysis of existing
products and literature on pediatric wheelchair users.
A key consideration in the design of any product is the end-user. In the realm of
consumer products, end-users often determine the success or failure of products by their
willingness to purchase. Therefore, many products attempt to appeal to the sensibilities of the
end-users. However, in the case of assistive technology for people with disabilities, often an
insurance company rather than the end-user purchases the product. Consequently, design is often
performed with the bottom line of the insurance payer paramount, healthcare provider
recommendations secondary, and user needs relegated to the bottom of the priority list. This can
have negative consequences for the end-users of assistive technology. In best case scenarios, an
assistive device can become an extension of the body. 3,4 It can become something that users rely
heavily on to perform even the most basic activities of daily living as well as a tool with which to
achieve life goals. In the worse case scenarios, a device can become not only a source of
frustration but can also lead to injury and secondary disabilities if improperly fitted or
inappropriately prescribed.
Looking at user needs expands designers’ technical understanding of the design problem
5,6,7
and potentially heightens their empathy for the user. In assistive technology design,
understanding user needs is paramount. Device designs which do not consider the users’ needs
8,9,10
are likely to be misused or abandoned. A goal of this project was to get feedback on the
design from pediatric wheelchair users, their parents, caregivers, and clinicians during the early
phases of product development through focus groups. In doing this, it is hoped that the end
product will be easier to use, more therapeutic, more appealing and provide a product
development model for assistive technology.

1
 The end users of this design are pediatric wheelchair users, their parents, and caregivers.
The term “pediatric wheelchair users” covers a broad spectrum of children with disabilities. The
PALM design aims to meet the needs of those children who, due to cognitive state and/or
physical disability are unable to independently shift their weight and transfer, may be unable to
maintain an upright posture and may be unable to communicate or ambulate and are therefore
highly dependent. Due to these disabilities, they may be at a high risk for secondary disabilities,
such as decubitus ulcers and postural deformities. Conditions such as severe cerebral palsy,
muscular dystrophy, mental retardation, and high-level spina bifida can lead to development of
this level of disability. Although the child is the primary end-user of this equipment, their parents
and caregivers are likely to perform tasks such as seat adjustments and transportation. Therefore,
their needs are crucial to consider as well.

1.1 WORLDWIDE NEED FOR PEDIATRIC WHEELCHAIRS

In the United States, there are over four million children under the age of 18 with disabilities,
and more than 10% of this pediatric population, or over 400,000, have physical disabilities such
as paralysis, Cerebral Palsy, or orthopedic impairments that may require the use of a
wheelchair.11 Internationally the need for pediatric wheelchairs is significantly higher,
particularly in developing countries where the population, poverty, and disability occurrences are
12 13
higher. In most of the world, poverty and disability go hand-in-hand. There are 1.5 billion
children worldwide living in low-income conditions and roughly 3.5 million of these children
live in India. According to surveys conducted by the World Bank in the last ten years, 15
countries (including India) reported that at least 80% of the population earns below $2 USD a
14
day. Average yearly income is thus below $730 USD, rendering many families incapable of
affording a wheelchair for a disabled child. Many of these countries do not have enough public
medical funding programs (such as Medicaid in the U.S.). The Wheelchairs for the World charity
that distributes wheelchairs worldwide reports that there are more than 21 million people in
developing countries in need of wheelchairs but many adults in these countries earn less than
12
$300/yr. Charities, governmental, and non-governmental organizations comprise the majority

2
of wheelchair purchasers internationally. However, to the detriment of wheelchair users, most
organizations purchase low quality depot-style wheelchairs because they are inexpensive.
The need for an appropriate wheelchair is even more severe for pediatric users. Many
children who receive donated chairs end up with chairs that are much too big and have no room
for growth adjustability. Some organizations provide adult-sized wheelchairs to children under
the assumption that a child may only get one wheelchair in his lifetime. However, these donated
wheelchairs often break or are abandoned because they are not usable. If used, these over-sized
wheelchairs can lead to secondary disabilities because of poor fit.
Pediatric wheelchair users are distinct from their adult counterparts because they
experience rapid physical growth and changing cognitive and functional skills. 15,16 Children also
find themselves in a variety of environments, some of which may require dependant mobility
systems in which they are pushed by others, while other environments may allow the child to
self-propel their own wheelchair – an independence that is important to encourage in a growing
17-19
child. Finally, pediatric seating and positioning must address social and environmental
demands unique to children while also minimizing the risk of secondary injuries such as pressure
ulcers and postural deformities. 20
It is not only in developing countries where the unique needs of pediatric wheelchair
users have been underserved. Although adult manual wheelchairs have improved dramatically
over the past two decades, innovations designed specifically for the pediatric population have
been lacking. This is, at least in part, because research and development efforts have focused
much more on independent adult wheelchair users than they have on children and their
21
caregivers. In addition, expert adult wheelchair users were the driving force behind the
22
wheelchair design revolution. When no existing products were sufficient to meet their needs,
people began designing and building custom products, started wheelchair manufacturing
companies, and the wheelchair design revolution was born. Naturally these products filled a gap
for these active and educated wheelchair users through creating ultra-light manual wheelchairs,
racing wheelchairs, and other sports chairs. Although some innovations from developments in
this industry have been applicable in pediatric wheelchair design, a child’s chair should rarely be
just a miniature version of an adult chair. This, combined with the smaller market need in
pediatric wheelchairs, means that the design of children’s chairs has lagged somewhat. This is
especially true for those children who have severe mobility disabilities, are highly dependent and

3
need highly supportive wheelchairs. The purpose of this project was to address this gap through
the research and development of a manual pediatric wheelchair specifically designed to meet the
complex needs of a growing child and his caregivers.

1.2 EXISTING PEDIATRIC WHEELCHAIRS

Key terms used in reference to seating and mobility:

Tilt-in-space: Tilting seat in which the hip and knee angles remain fixed, while the seat tilts
posteriorly or anteriorly. This type of seating preserves postural alignment while changing the
orientation of the body to gravity. 23
Center-of-gravity tilt: A tilting system in which the user’s center of gravity remains relatively
stable while tilting. This allows for a shorter wheelbase and more stable chair. Figure 1
illustrates the problem that arises when the seat is tilted posteriorly without a simultaneous shift
forward. This leads to the center of gravity moving up and back.

Figure 1: Tilting seat posteriorly without shifting seat

forward results in the center of gravity moving up and back.

4
Pediatric wheelchairs fall into the following categories: power, power-assist, manual, attendant
propelled, hybrid, tilt-in-space, and strollers. This research and development effort focuses on
hybrid, manual, attendant-propelled, tilt-in-space, and strollers. Hybrid wheelchairs combine
multiple functions into one wheelchair. They may be able to adapt to different environments,
with a removable seat that can be used on a feeder chair base, jogging stroller, or tilt-in-space
frame. One example of this kind of wheelchair is the Thomashilfen EasyS rehabilitation stroller
(http://www.thomashilfen.de/easys/index_english.htm). Designs such as this are interesting in
that they reflect the reality that children perform many different types of activities in different
environments and may require different chairs in order to adapt to the different environments.
Many manual, tilt-in-space pediatric wheelchairs are currently on the market. However,
as noted, all of these chairs have limitations. Table 1 describes some popular products on the
market in the U.S. and points out their unique features and limitations.
Currently the average cost of a pediatric, tilt-in-space wheelchair is $1700-$3000.
Pediatric wheelchairs with additional features to accommodate comfort, ease of transportation,
and growth adjustability have an increased price range of $2200-3000. The weight ranges of tilt-
in-space wheelchairs usually fall between 40-50 pounds with standard components (See Table 1
for comparisons). An example of a pediatric chair that has both positive features and limitations
is the Solara by Invacare. This widely prescribed chair minimizes change in the center of gravity
through its 45° range of tilt allowing for a smaller wheelbase while maintaining stability.
However, the Solara costs upwards of $2100 and is heavy at 43 lbs. The Solara Jr., a lighter
weight model, costs upwards of $2700. Lighter tilt-in-space strollers are available but typically
cannot be adapted for self-propulsion and often do not have enough adjustability to
accommodate complex seating needs. Strollers are a frequent choice for parents of young
children with disabilities. This is due to several reasons; 1) they are “normal” in appearance, 2)
24
they are lightweight and easily folded, 3) they are inexpensive. However, the most portable
strollers typically have sling seating and are not usually supportive enough for children with
mobility disabilities and are inappropriate for long periods of sitting. 24 “Adaptive” strollers have
the more appealing stroller aesthetic but have supportive seating for children with disabilities and
are a better option than a standard baby stroller. However, these strollers may not be appropriate

5
for a school environment and may not have tilt-in-space seating and other features important in a
truly accommodating mobility system. 25,26

Table 1: Examples of currently available pediatric wheelchairs

Weight Cost
Product Unique features Short comings
(lb.) (USD)

Bulky frame, heavy, center of

Invacare Orbit Detachable seat
gravity change, institutional 45 1916
frame
aesthetics

Kid Kart Folds, reversible seat No self-propulsion capability,

34 1605
direction center of gravity change

29
Invacare Solara
(Without
Jr. Stable center of 2754
institutional aesthetics seating or
gravity, light weight
footrests)
Stroller is not appropriate for
Otto Bock
Spring shocks/ older children, center of
Kimba Pediatric
Articulating leg rests gravity change, institutional 36 2800
(stroller)
aesthetics, not collapsible

Sunrise Zippie Adjustable Depth/ Bulky frame, heavy, center of

Pediatric TS Angle footrests gravity change, institutional 49 1689
aesthetics
Compact for easy 29
Invacare Spree
moving and Center of gravity change, (Without
XT 2895
adjustability institutional aesthetics seating or
footrests)

1.3 UNIQUE NEEDS OF PEDIATRIC WHEELCHAIR USERS

1.3.1 Physical growth and change

16
Children grow rapidly and are in need of wheelchairs with growth adjustability. Most young
children, regardless of disability, will experience dramatic changes in size, cognitive, functional
and social skills over time. Changing function for children with disabilities may stem from

6
rapidly progressing diseases, an improving condition due to rehabilitation, medical intervention
or normative developmental changes.
Most pediatric wheelchairs fulfill the adjustability requirements for seating as the child
grows, yet fall short when changes must be made to accommodate changing function. In order to
accommodate rapid changes in growth and function experienced by pediatric wheelchair users,
the wheelchair needs to be either frequently replaced or the wheelchair needs to be able to adjust
and grow with the child in both size and function. Using an improperly fitted chair which has
been outgrown can further impede physical and cognitive development and will likely increase
17,18,19,20
the risk for secondary injuries such as pressure ulcers. The economic cost of frequently
replacing a wheelchair is out of reach for most middle- and low-income families. In most states
Medicaid will only reimburse wheelchair users for the cost of a new wheelchair about every
26
three years. Importantly, to address these changes, frequent wheelchair replacement is cost
prohibitive and brings with it the challenges associated with repeated adjustment to a new
wheelchair.4 Thus, frequent replacement of the wheelchair is far from an optimal solution.
Without replacing the wheelchair, this can only be achieved through highly adjustable
components and/or modular multi-sized components. The adjustments are often cumbersome,
difficult to adjust, and add excess weight to the chair. This problem represents one of the main
challenges in pediatric wheelchair design.

1.3.2 Mobility

For children with mobility disabilities, effective mobility can be provided by power, power
assist, manual self-propelled, or manual attendant propelled wheelchairs. This research
investigates the option of manual and manual attendant-propelled wheelchairs which are
typically used for younger children or those who are incapable of operating a power chair.
However, in cases where children clearly cannot self-propel a manual wheelchair but have the
ability to control a power chair and a medical reimbursement can be obtained, then the child will
typically receive a power wheelchair. In cases where a power wheelchair is not an option
(because of cost or ability limitations), a manual attendant-propelled chair is a reasonable
alternative.

7
 Whether or not a child is able to self-propel a manual wheelchair may vary over time and
the environment of use. Because the child’s ability and environment are always changing these
changes will affect the extent to which manual self-propulsion is an option. To maximize
opportunities for self-propulsion and to accommodate changing abilities and changing
environments, a manual pediatric wheelchair with the capability of easily converting from an
attendant-style wheelchair to manual self-propelled chair, could fill this gap. 17-19 For a child who
is capable, having the option to propel or adjust his/her location and orientation independently is
critical.

1.3.3 Self-sufficiency of child

Research conducted in the psychology discipline has uncovered substantial evidence of the need
27
to feel in control of one’s environment. This need for a sense of control could be especially
acute in children with disabilities. If self-sufficiency and independence are not encouraged
whenever possible, then existing disabilities may feed into additional developmental deficits in
28
learning and communication. On the other hand, when independence and self-sufficiency are
17-19
encouraged, it may help to facilitate exploration and stimulate intellectual growth. Thus, a
pediatric wheelchair should be designed to maximize the degree to which the user feels in
control of his/her situation; whether this means propelling the chair, adjusting the seat, or
manipulating some aspect of his wheelchair environment. This demands that the features of the
wheelchair are easy to use and that the methods for adjustment or manipulation of the wheelchair
are transparent. The ability of a child to perform tasks and make choices must be encouraged in
order to avoid the consequence of “learned helplessness.” 29 Some dependent mobility chairs are
now being offered with a power tilt function. This power tilt can be operated with a simple push
button and allows the user to have control over their sitting position even if they are unable to
operate power mobility. Power seating can also be used as a precursor to power mobility. As
with all add-on features though, the caregiver must make a trade-off decision, because a power
actuator adds weight to the wheelchair. Wheelchairs that can be positioned to allow for
independent or assisted transfers, as opposed to fully dependent transfers, give a degree of
independence to the rider. In many cases, cognitive disabilities are the main barrier to self-

8
sufficiency. In the event that a child is able, the wheelchair should provide a means to
independent activities.

1.3.4 Comfort and enjoyment

Comfort is a key feature to functionality for both adults and children. Comfort facilitates one’s
ability to focus, learn, and explore. Conversely, discomfort may lead to abandonment of the
wheelchair, which adversely affects rehabilitation and may lead to further injury.10 Not
surprisingly, research indicates that highly adjustable wheelchairs are perceived as more
comfortable than those that are less adjustable.4 Comfort is also important for the caregiver who
needs to take the chair apart, transport and push it.
Comfort is not only physical, but also psychological. The child and parent should be able
to “feel good” about the wheelchair – that it be seen as a vehicle for exploration of the world.
Without aesthetics and features that “speak” to a child’s need for comfort and exploration, a
child may feel trapped in the wheelchair. As one of the primary means by which a child with a
disability may explore their world, the wheelchair must help promote development, learning,
growth and health, rather than act as a barrier. Aesthetics can cause a parent to choose one
wheelchair over another.24,9,10 The ease with which a parent pushes, adjusts or transports a
wheelchair will often determine what wheelchair is purchased. Good design not only facilitates
ease of use but also addresses the need for an aesthetic which a parent and child can feel content
with. Good design can minimize the stigma associated with disability in most societies and in the
current trend of rapid technology acceptance; design can transform assistive technology into
desirable technology. 24,7

1.3.5 Seating

Children who, due to diagnosis or age, are unable to independently shift weight and relieve
pressure are at risk for the development of decubitus ulcers.20 The tilt-in-space manual
wheelchairs currently available are often very bulky, scaled-down versions of adult chairs. To
further prevent the development of secondary disabilities and deformities, a pediatric wheelchair
must also accommodate different degrees of supportive seating. The seating should also be
9
dynamic, allowing for tilt and in some cases recline. Good seating postures can improve
breathing, eating, digestion, circulation, and cardiovascular function. In an ideally designed
pediatric chair, both caregiver and child (if appropriate) would be able to adjust the dynamic
seating. Additional features, such as seating systems that can attach to both manual and power
bases or manual chairs with detachable power modules, are also beneficial. Any added flexibility
built into a design can potentially benefit a child who may be able to take advantage of the
features.
Tilt-in-space seating is also useful for transfers, easier toileting, feeding, breathing, and
napping as well as stability during propulsion down hills and over rough terrain for children who
can’t stay upright.
Due to the complexity of postural deformities that can arise in children with mobility
disabilities, a wide range of seating adjustments is needed. These postural deformities include;
scoliosis, which can occur when the pelvis has an asymmetrical position over time, contractures
which can be caused by long-term sitting in one position without change, or if the child is seated
in a way that keeps the body tense and flexed for long periods.30 A wide range of postural
supports must be available for selection by a seating and mobility specialist. These supports are
used on the wheelchair seat based on the specific needs of the user, disability type, postural
condition, and medical treatment plan. A range of supports must be available for the clinician to
choose from in order to build a truly accommodating seat. They include; lateral trunk supports,
hip guides, head rest, lateral thigh supports, armrests, and abduction block. 24
Straps and belts can be dangerous to the child if not used properly and therefore more
adjustability and flexibility in seating supports is desirable. Restraints are sometimes used to
maintain posture or to keep a child in the chair; however, these restraints can cause discomfort
leading to restlessness, concentration problems, and often the restraints do not aid the underlying
30
postural problems. In some cases, straps and restraints can be dangerous. Butterfly harnesses
31,32
have led to some cases of strangulation. A wheelchair that can accommodate highly
specialized off-the-shelf seating components is likely to be most prescribed for children with
highly complex seating needs.

10
1.3.6 Transportation of wheelchair and child

A well-designed pediatric wheelchair must be easily and safely transportable. Just as able-bodied
children must wear seatbelts for safety while traveling in cars, children who use wheelchairs
must be secured either within their wheelchair which in turn is secured to the vehicle, or they
33
must be secured in a passenger seat for safety. Wheelchairs that comply with the wheelchair
transportation safety standards are equipped with securement anchorage points and are crash
34
tested according to the standards. These standards are voluntary; therefore many wheelchairs
do not comply with the standard. However, because a large number of pediatric wheelchair users
ride buses while seated in their wheelchairs, transportation safety is likely to be a large factor in
deciding which wheelchair to purchase. 35
The ability for a wheelchair to be safely secured within a bus is just one feature of
transportability. Unfortunately, the extra material needed on a wheelchair in order to make it
crashworthy is also likely to add substantial weight to the chair making it harder for a caregiver
to lift and transport in a passenger vehicle. The transportability of a wheelchair is also
determined by the ease with which a caregiver can transfer the child from the wheelchair,
collapse the wheelchair, and store it in a vehicle as cargo.
In some cases, the wheelchair seat may be removed and used as a car seat. This requires
that the seat meet federal motor vehicle safety standards. In some regards, this is a good concept;
however it has two main limitations. First, car seats are typically built on a plastic molded shell,
30
often with 90-90-90 seating which is rarely appropriate for long periods of sitting. Car seats
with reclining seat backs are preferable.

1.3.7 Consequences of inadequate pediatric wheelchairs

A wheelchair that does not accommodate a child’s seating and mobility needs may have serious
consequences in a variety of areas including chronic discomfort, increased risk for secondary
injuries, and poor cognitive and social development of the child. Research indicates that
improperly fitted, non-adjustable, wheelchairs increase the risk of acquiring decubitus ulcers,
36
growth deformities and secondary disabilities, which in extreme cases, may lead to death.
Pressure ulcers are a common secondary injury among pediatric wheelchair users. 20 In addition

11
to the physical risks posed by an inadequate wheelchair, there may also be dramatic effects on
the cognitive and social development of the child. A wheelchair that is unable to grow with the
child may feed into a downward cycle in which existing disabilities feed into additional
17-19,28
developmental deficits in learning and communication. Improper seating for a child can
mean the difference between good cognitive and physiological development and poor
development. A wheelchair that ends up restricting mobility (due to poor fit and function) rather
than facilitating ease of movement will have a negative impact on the cognitive, scholastic, and
17-19
neuropsychological development of the child. During the course of childhood, it is difficult
to overestimate the seriousness of these consequences. 37

12
 2.0 STATEMENT OF PROBLEM

Many currently available pediatric wheelchairs fail to meet many of the needs of the pediatric
wheelchair population and their parents and caregivers. Chairs that aim to meet these needs are
often either bulky, cumbersome to adjust, or expensive. The driving purpose of this project was
to create a pediatric wheelchair that meets the complex needs of the pediatric wheelchair user
population and their caregivers. These needs include a tilt-in-space pediatric wheelchair that
maintains a fixed center of gravity and is adjustable, lightweight, modular, ergonomic, easy to
use, comfortable, durable, and lower in cost. A design such as this would not only benefit end-
users, but could also be useful as a practical and affordable option in rehabilitation hospitals
where depot-style wheelchairs are most commonly used and could make in-patient treatment and
transition to out-patient care more healthy and comfortable. In addition to enriching the U.S.
pediatric wheelchair market, this product could also benefit the international wheelchair market,
particularly in developing countries where there is a great need for high quality low-cost
wheelchairs.

13
 3.0 AIMS

The overall aim was to create a pediatric wheelchair that meets the complex needs of the
pediatric wheelchair user population and their caregivers. In order to do this, focus groups and
research needed to be carried out in order to understand these complex needs.
This project consisted of three phases. The first phase, the “India PALM” was a proof-of-
concept phase consisting of design and prototyping. The India PALM model had many
functional problems but served as a good basis on which to build the second phase, the “U.S.
PALM.” The India PALM model was presented to clinicians and manufacturers in India for
feedback. The U.S. PALM model was a more refined development model and was used for
durability and fatigue testing and focus group evaluations in the U.S. The objective of the third
phase, the “Final PALM,” was to further refine the design based on the earlier phases and to
develop a more aesthetically resolved prototype that is closer to a pre-production model. A focus
group was conducted to gain feedback on this third stage of the design.

Figure 2: Iterations of the design: Phase 1 (India PALM) Phase 2 (U.S. PALM)
& Phase 3 (Final PALM)

14
 4.0 WORK PLAN

All design and prototyping work was done in-house at HERL utilizing the machine shop.
Testing was incorporated throughout the process. The following flow chart (Figure 3) illustrates
the design process used. The description of this project flows chronologically, starting with the
India PALM, followed by the U.S. PALM and ending with the final PALM. A subsection will go
into more detail about the design and prototyping process.

15
 Develop design
Flow chart key concepts
Design step

Prototyping step
Concept models
Feedback step “India PALM”
development
Testing step model PALM v1 build

Feedback from
Indian therapists

Design refinements

PALM v2 build
“U.S. PALM”
development
model
Focus groups ANSI/RESNA
testing

Design refinements

Build scale models

“Final PALM”
Build PALM v3
alpha model

Focus group

Figure 3: Flow chart describing work process

16
 4.1 DESIGN PROCESS

The process of designing the PALM was an iterative one, with each model building and
improving on the last. Each prototype was appropriate for its product development stage. This
section covers the types of prototypes used at each stage and their purposes. Each type of
prototype is defined first, followed by an example from the PALM process. All the models
contributed to the problem-solving and design process. Although the PALM project has not been
carried through the final stages, this outline will explain the logic of the design process.
Depending on the complexity of the project and the experience of the design team, some steps
may be skipped, but by following through with each level of modeling, the end product will have
fewer glitches and the process from start to finish will likely be more efficient and less costly.

Concept models: These models are made using

simple methods. The model typically focuses on
only one aspect of the design or on the overall
concept. The purpose is to communicate a concept
rather than details. Concept models can be made
throughout all stages of the design process. Figure 4: CAD Figure 5: SLA concept
model model

The design was conceptualized on paper first using hand sketching (Figure 6 & 13);
these concepts were then further detailed using CAD (computer aided design) software.
SolidworksTM was used to design and test the four bar linkage tilt mechanism for interferences.
Concept models were made using Stereo Lithography (SLA) rapid prototyping.

Developmental prototypes: The purpose of these prototypes is to demonstrate a “proof-of-

concept” and for internal testing. Rather than the kind of final testing procedures performed on a
product before it goes to market, this testing serves as a problem-solving step and is used to

17
further develop and optimize the design.
Emphasis is placed on the functions of the
prototype rather than on the look and feel.

The US PALM and Final PALM

prototypes fall in this category. Fairly
detailed CAD models were made of these
wheelchairs; however, during the
prototyping process, tweaking and
spontaneous design changes were made in
the machine shop. These prototypes
served as test platforms for two key design
concepts; 1) a modular design using
plastic nodes to join straight tubes and 2)
Figure 6: Hand sketches from early concept stage to final stage
the four-bar linkage tilt mechanism. These
concepts provided plenty of design
challenge in themselves; therefore the
challenge of designing a seating system
was left for the next design phase.
The India phase prototype was
constructed from mild steel 1” OD, .049
WT tubing. The seat pan and footplate
were CNC milled from black ¼” ABS Figure 8: India PALM Figure 7: US PALM
plastic. The foot rest brackets were
machined on the wire EDM (electrical discharge machining) from 14 gauge cold rolled mild
steel. Other footrest components were machined on the lathe and CNC milled from 6061
aluminum. All other components are OEM components. Parts were drawn in SolidworksTM and
then either hand-machined or exported into Feature CamTM software for CNC milling or wire
EDM machining. Rather than using injection-molded polyethylene components in the prototype
stage, the plastic components in the India and US phases were machined from Delrin plastic.
This allowed greater flexibility when components needed to be redesigned and machined. SLA

18
was impractical because the resin available at the time of prototyping v1 was too brittle to use in
full-scale functional parts.
Between the first and second prototypes, some of the materials used shifted from mild
steel to 6061 aluminum tubing and bar stock and Chromium-Steel Alloy (SAE 4130) seamless
tubing. This was primarily because the PALM design was meant to be versatile enough to be
manufactured using lower-cost materials in developing countries and higher-end materials in
developed countries, all the while using the same injection molded components. In terms of
prototype construction, the India PALM is closer to the materials that would be used in the
developing country version and the final PALM is closer to that which would be used
domestically. The final PALM was constructed from 6061 aluminum 1” OD, 0.60” WT tubing.

Industrial design prototypes: The purpose of this type of model is to demonstrate the look and
feel of a final product. Its main purpose is for gaining feedback from users and stakeholders. The
leap in imagination from concept and development model to a final product can be difficult for
people who aren’t designers or engineers. The industrial design prototype may not look exactly
as the final product will; however, it conveys the sense of a final product. A three dimensional
full scale model is indispensable for gaining input from users even if the prototype is not fully
functional.

Alpha prototypes: This prototype has mostly full-features and can

be used for internal testing. It may have some of the same materials
and properties as the final product, but uses different manufacturing
processes than would be used in full-scale production. For example,
rather than using injection molding, rapid prototyping and soft-
tooling would be used for plastic parts. Rather than stamping, CNC
and EDM would be used for making sheet metal parts.
Figure 9: Final PALM

The final PALM prototype is somewhere between an industrial design and an alpha
prototype. Because the previous development models did not focus on the seat design, the final
PALM seating system is really in its first iteration, whereas the other areas of the wheelchair, the
base and tilt system are more refined and closer to an alpha prototype.

19
 The final PALM is constructed from aluminum tubing, machined parts and plastic
components made using the Stereolithography (SLA) process and a resin with properties similar
to ABS plastic. The parts weren’t to be used for in-home-user trials or ANSI/RESNA durability
testing, but were suitable for a focus group and give a sense of a final product.
Because the design was not fully resolved at
this stage, SLA prototyping was appropriate.
Selective laser sintering (SLS) is a rapid
prototyping process yielding high resolution parts
similar to those produced with SLA, however,
higher strength materials are available. If the parts
were to be made using SLS instead of SLA, the
prototype could likely be durability tested and used
for in-home trials, however, part geometries and
design features should be fully resolved before this
Figure 10: Final PALM backrest and half scale
step is taken. Half scale SLA models were used to experimental model made using SLA
work out design details. (Figure 10)
Parts made for the final phase were intended
to look like factory-made parts. Parts
that would be made from stamped
aluminum or steel in a full production
stage were CNC machined from
0.0625” or 0.125” sheet aluminum and
bent on the sheet metal brake. The
resulting parts look similar to factory-
made parts, even though each was
individually crafted. Figure 11
illustrates the process of CNC milling
the aluminum sheet metal, the cut
footplates, and the final powder coated Figure 11: CNC manufacturing, cut part prior to bending and final
product after finishing and powder coating
part assembled on the wheelchair.

20
Figure 12: Images of SLA process. Vat in which parts are made, Unpainted SLA parts and
SLA parts finished and assembled on final prototype

Figure 13: Hand concept sketches of rear plastic joints and backrest

21
Beta prototype: This prototype contains all the features of a final product. Comprehensive
internal testing and external evaluation can be performed with a Beta prototype. It will likely use
a combination of final production methods and rapid prototyping processes using material with
equivalent properties to that which is necessary in a final product. For example, SLS could
replace injection molding or even soft-tooling, if it is more cost effective. Testing in addition to
finite element analysis (FEA) should be performed to ensure part equivalency between the
different manufacturing methods. Beta prototypes, which should be durable and safe, can be used
for take-home trials with users.

Pre-production prototype: This is the final step before a product goes to market. The prototype
is manufactured using full production methods in small volumes. Whereas previous prototyping
steps are intended to tune the design, this step is used to troubleshoot the manufacturing
processes, assembly procedures, and identify any problems with production tooling. The short-
run prototypes can be used for release to key customers.

22
 5.0 INDIA PHASE

5.1 ANTHROPOMETRY

Anthropometric data for children with disabilities are unpublished; therefore dimensions of able-
bodied children were used in this design. A large age range was chosen, 3-14.5, in order to
accommodate most children and pre-teen wheelchair users. The PALM wheelchair is highly
adjustable and selectable to accommodate this range of body sizes and accommodate a child
weighing up to 50 kg. Although individuals are considered children until age 18 in the U.S.,
many teenagers are large enough to fit in adult wheelchairs. Wheelchairs with components
capable of accommodating the full range of growth, through age 18, can add substantial weight
to a wheelchair. In order to keep the wheelchair lightweight, it could be available in small and
large sizes, each with a range of adjustability. Table 2 indicates the anthropometric data used for
38
the PALM wheelchair design. Figure 14 illustrates the ranges of adjustability built into the
wheelchair based on the data.

23
 Backrest
height:
up to
16”

Seat depth: Seat width:

up to 17” up to 13”

Leg length:
up to 15”

Figure 14: Illustration showing the range of growth adjustability built

into the wheelchair based on anthropometric data

Table 2: Anthropometric data used to determine PALM range of adjustability. 38

MEASUREMENT (male & female) RANGE OF MEANS

weight 14.1- 50.8 kg 31-112 lbs

max hip breadth (seated) 19.1- 31.1 cm 7.5-12”

max thigh breadth (seated) 19.2- 31.6 cm 7.5-12.5”
erect sitting height (seated) 54.4- 82.4 cm 21.5-32”
buttock-knee length 28.4- 54.3 cm 11-21”
knee height 27.0- 50.7 cm 10.5-20”
shoulder breadth 24.4- 38.6 cm 9.6-15”
foot length 14.7- 24.6 cm 6-10”

seated CoG (above seat) 20.1- 22.8 cm 8-8.5”

seated CoG (from back) 13.1- 22.8 cm 5-9”

24
 5.2 INDIA PHASE DESIGN

5.2.1 Design criteria

Design criteria were determined based on research of existing products, informal discussion with
seating and mobility clinicians, and literature review. Several design criteria were defined at the
beginning of the India PALM project. These included:
1. Tilt-in-space function with posterior/anterior tilt
Tilt-in-space seating is important to relieve pressure, improve posture, aid in feeding,
toileting, napping and breathing. Anterior tilt aids children in performing standing pivot
transfers and for performing activities when seated at a table.
2. Seat adjustability; reclining seat-back, leg rest angle, foot plate height, seat depth
Seat adjustability is important for accommodating children’s varying and growing body
sizes as well as for achieving a comfortable body position throughout the day. Some
adjustments must be performed frequently, while others may be infrequent.
3. Exchangeable manual-propulsion and assistant-propulsion rear wheels
For children who are capable of self-propulsion, the option for a manual propulsion
wheel is important, while other children who are unable to self-propel may benefit more
from the durability and added cushion of a small diameter wheel with a thick tire.
4. Adjustable manual-propulsion wheel axle position
For children who are capable of self-propulsion, adjustable axle position is needed to
reduce risk of shoulder injury.
5. Overall weight less than 40 pounds
Although this is quite heavy, the most realistic material for low cost production in India is
low carbon steel, therefore, the wheelchair was expected to be heavy. This should be
minimized as much as possible, and other materials such as plastic tubing could be
evaluated for their feasibility in India.
6. Collapsibility for transportability
In India, many people travel via train or bus, therefore the wheelchair should be
collapsible to ease transport.

25
7. Durability
The wheelchair should meet or exceed the durability standard set forth by the
ANSI/RESNA wheelchair standards.
8. Low cost
The Indian government provides $150 USD subsidy for people with disabilities who need
wheelchairs and cannot afford one.
9. Manufacturability in India
To keep cost low, the wheelchair should be made from local materials. In India,
aluminum and alloy steels are quite expensive. By far the most common material is low
carbon steel. Plastics and injection molding are available and because of their use in
Indian prosthetics, they are a realistic choice for use in wheelchair manufacture.

5.2.2 Innovative concepts

The novel features of the PALM wheelchair can be broken down into two categories: 1) modular
construction and 2) tilt-in-space linkage mechanism.

5.2.2.1 Modular construction

The wheelchair components consist of plastic injection molded modular components and tubing.
All joints are connected without the use of welding. This greatly reduces the manufacturing costs
and complexity compared to other tilt-in-space chairs on the market. The use of plastic modules
allows the chair to break down into smaller units than comparable chairs on the market, thereby
reducing shipping costs. This feature also allows the chair to be more easily customized on site
because the therapist can select the size of parts.

26
 Figure 15: India PALM prototype

In order to allow for growth and maintain a relatively lightweight frame, the modular
design allows non-adjustable components to be removed and new properly sized components to
be selected. If all components were adjustable, the wheelchair would have added weight and the
adjustability would inhibit usability. The modular design allows for great flexibility in the
configuration of the wheelchair and adaptation to different sized bodies.
A modular design provides the following benefits over an integrated design: 1) the
wheelchair can be shipped as a kit-of-parts to be assembled on-site, thereby reducing shipping
costs. 2) Should a component break, it can be swapped out and replaced, extending the life of the
wheelchair. 3) The chair can be configured to meet the user’s need, whether in terms of size
changes or functional changes, allowing the chair to be lighter weight and more universal. Most
pediatric chairs have a high degree of adjustability built in, which makes them quite heavy (many
are 40 lbs and above). By replacing modular components rather than building all the growth
adjustability into one integrated system, a modular design could accommodate the same breadth
of human sizes but achieve an overall lighter weight. With a modular design this customization
can be done on site rather than in a factory.
The plastic injection modules used in the PALM could reduce cost and increase
flexibility by being used in multiple chair designs. The plastic injection molded components
could be universal, whereas the metal tubes could be made of different metals. In a developing
country, lower cost steel could be used whereas in the U.S. higher grade materials could be used.
Use of the injection molded components further reduces cost and increases manufacturing
precision by eliminating the need for weld jigs. The use of plastic nodes in this design minimizes

27
the use of tube bending and welding, thus reducing manufacturing complexity. In addition, the
chair can change from manual-attendant propelled to push-rim self-propulsion.

5.2.2.2 Tilt-in-space mechanism

The tilt mechanism uses a four-bar linkage design (Figures 16, 17). The goal was to create a tilt
mechanism that minimized the COG shift. This design decreases the need for small moving parts
such as rollers and spring loaded mechanisms that are typically used in other tilt-in-space center-
of-gravity chairs.
The tilt-in-space mechanism utilizes a four-bar type mechanism constructed from 0.75”
aluminum tubing and plastic nodes. This mechanism allows the occupant to be tilted in the seat
while minimizing a shift of the center of gravity. Although other chairs on the market use the
concept of “center-of-gravity” tilt, none use a linkage such as this to achieve it. The linkage
design decreases the need for small moving parts such as rollers and spring loaded mechanisms
that are used in other tilt-in-space center-of-gravity chairs. In addition, the linkage mechanism is
a lightweight, durable and low-cost design for a tilt-in-space system. The tilt locks via cable
release and Mechlock,TM a common method used in commercial products.

Figure 16: Side view of India PALM in tilted Figure 17: Side view of U.S. PALM.
position. Lines indicate position of four bars in Improvements to linkage geometry were made
linkage. between versions.

28
Figure 18 illustrates the process used to develop the
tilt-in-space geometry. The sketch does not show the
final linkage geometry, but illustrates the concept. The
cross-hatched circle indicates the center-of-gravity
(CoG). This point would not remain fixed due to the
variation in body sizes among children; therefore, the
goal is to keep the CoG relatively stable. The arc
A
represents the tilt path if the seat is tilted around the
CoG. Simple geometry methods were used to devise the
optimal tilt geometry, the linkage arm lengths and the
pivot points. The key constraint was that the linkage arms
Figure 18: Process sketch of tilt mechanism
needed to be contained within the space beneath the
wheelchair.
With varying body sizes and a dynamic child, it is impossible to predict exactly where the
CoG will lie. Therefore the wheelchair was designed to accommodate a larger range of CoG
positions. The effort required to tilt the seat was minimized by placing the arc of the rear linkage
arm A (Figure 18) in an anteriorly tilted position. When the seat is tilted, the arm is in a position
to allow an easy downward arcing tilt. The caregiver need only control the tilt as opposed to lift
the CoG of the child.

5.2.3 Concept development

Initial concepts were developed using Solidworks software (Figures 19) and SLA prototyping.
The India PALM prototype (Figure 15) was not tested to ANSI-RESNA standards or in a focus
group. It was built as a development model for the purpose of design experimentation and as a
point of discussion. Through the process of building and working with this model, features were
identified for design improvements in the second version.

29
 Figure 19: Initial concept drawings made prior to PALM P1 construction

5.3 INDIA PHASE CONCLUSION

To insure that the design was low cost and easy to manufacture, the India PALM
prototype was presented to a wheelchair manufacturer in India, the Artificial Limbs
Manufacturing Corporation (ALIMCO), and to the Indian Spinal Injury Center (ISIC), the
leading rehabilitation hospital in India. The team visited ISIC and held a workshop with
occupational and physical therapists in the clinic. During the workshop the team demonstrated
the prototype and held an informal discussion using the prototype as a point of discussion. The
clinicians offered many opinions on how the prototype could be improved. These opinions
contributed to the design criteria for the next phase.
At this point commitment in India waned and funding changes required the team to seek
funding and a partner in the U.S. in order to continue the work. Thus, the next phase of the
project is “US PALM.”

30
 6.0 U.S. PHASE

The US PALM was built as a second development model. It was an improvement over the India
PALM which had many functional limitations. Based on the informal feedback from Indian
clinicians and manufacturers as well as obvious design problems, the design was refined and the
U.S. PALM was built. This version was evaluated formally in focus groups with clinicians in the
U.S. and was tested to ANSI/RESNA standards.

Figure 20: US PALM prototype

6.1 U.S. PHASE DESIGN

There are several design criteria that differ between the U.S. and the Indian context. These
differences in general terms are; materials, money, manufacturing, wheelchair prescription
process, environment of use, and repairs. High-end lightweight materials such as aluminum,
titanium, high carbon alloy steels and carbon fiber are impractical in most developing countries

31
and heavier low carbon steel is abundant. Using high-end materials in a U.S. product is almost a
necessity for competitiveness and although they are expensive, medical reimbursements will
typically cover the costs. These materials allow for a stronger and more lightweight product. The
minimum expected level of quality in the U.S. is substantially higher than in India.
The environment of use in the U.S. and India are quite different. The U.S. environment is
fairly accessible with flat pavement, school buses with lifts, cars with large trunks and mostly
accessible public buildings. Although the Indian environment of use can be very hard on
wheelchairs, an active wheelchair user or active caregiver in the U.S. will likely want a
wheelchair that can be taken in the grass, over rough terrain in parks, cracks in the sidewalk and
potholes. Therefore, the stresses imposed on the wheelchair are likely similar to those of a
wheelchair in India. However, should the wheelchair break, it is much harder to replace in India,
and in addition, the funding available to purchase a wheelchair in India is likely to be much less
than what is available in the U.S.. In terms of prescription, in the U.S. a therapist will almost
inevitably be involved in the wheelchair prescription process as well as in the continual
maintenance of the wheelchair and ordering of any parts that may break or wear out.
The India PALM had certain design limitations which were addressed in the US PALM.
Table 3 shows a list of items in the left column which proved problematic in the first version and
the right column explains how these problems were addressed in the U.S. Phase. One main
limitation was the tilt mechanism. The linkage arm geometry shifted the CoG too far forward
(Figure 16 & 17) placing too much weight over the front casters and the locking mechanism for
the tilt was awkward. The tilt geometry was redesigned and a smoother OEM locking
mechanism, MechlokTM, was used in the US PALM prototype. The Mechlok mechanism is used
frequently for tilt-in-space and recline adjustments on wheelchairs and airline seating. It provides
a strong locking mechanism with few moving parts and is durable. The US PALM (Figure 20)
worked more smoothly, was sturdier and optimized for manufacture in the machine shop than the
India PALM. The US PALM was highly adjustable and selectable to accommodate a range of
body sizes. The seat depth, seat width, back rest height, back rest angle, leg rest angle, footrest
angle, and axle position are all adjustable. It also converts from an attendant-style wheelchair to
a self-propelled wheelchair.

32
 Although adjustability was a large consideration in U.S. PALM, seating components
were not given much design thought. A seating system is a fairly complex design problem;
therefore its resolution was left for the Final PALM.

Table 3: Problems with India PALM and resolution in US PALM

Design Problem in India PALM US PALM solution

Tilt-in-space shifted center of gravity too
far forward over front casters
Tilt-in-space locking mechanism was
hard to use and not smooth
Holes drilled in tubing for adjustments
were likely to weaken tubing
Embedding caster housing in plastic
created non-sturdy caster housing mount
Complicated machining of some plastic
components
Non-sturdy back rest angle adjustment
mechanism
Complicated wheel axle attachment
mechanism
Non-quick release arm-rests
Refined four bar linkage design by changing lengths of
arms and pivot points
Changed from two locking gears to a one cylinder
MechlokTM
(www.plporter.com/home/net/mechlok_001.html)
Use pinch clamps instead of bolting through tubes
Used an aluminum bracket to hold caster and bolt to plastic
module.
Decrease CNC milling setups from 2 to 1.
Use some aluminum components rather than all plastic.
Redesign component geometry.
Redesign axle plate mounting geometry and axle housing
Switch to a flip-up style armrest rather than a T-style which
bolted to the frame

The US PALM prototype had the following features:

1. Tilt-in-Space function with 35/10 degree posterior/anterior tilt
Although it is recommended that the seat have 45 degree posterior tilt, the range of
the MechlokTM used was only 45 degrees. A Mechlok with 55 degree range would be
used in a final product.
2. Exchangeable manual-propulsion and assistant-propulsion rear wheels
33
 3. Reclining seat-back function with 20 degrees posterior recline in 5 degree increments
4. Adjustable leg-rest angle (0-90 degrees) and 6” of leg-rest length adjustment
5. Foot-plate plantar/dorsiflexion angle adjustment
6. Adjustable manual-propulsion rear wheel axle position: 0-4” from backrest
7. Overall weight of 32 pounds
Although this is still fairly heavy, most products on the market weight around 40 lbs.
8. Overall size dimensions of 22” wide x 36” long x 30” high fully assembled
9. Stowage dimensions of 12” x 18” x 30” when disassembled to fit in a compact car trunk.

Figure 21: Side view of US PALM showing points of adjustability

6.2 FOCUS GROUP EVALUATION

To evaluate the US PALM, two focus groups were held at the Center for Assistive Technology
based at UPMC (University of Pittsburgh Medical Center) with a total of ten pediatric

34
wheelchair seating and mobility clinicians (therapists, rehabilitation engineers, and rehabilitation
technology suppliers) and three child/parent pairs. The main inclusion criterion for children was
that they had a mobility disability and used a manual wheelchair as their primary means of
mobility. The sample size is quite small, however for the focus group purposes, this was not
critical. The main goal was for the designers to hear some end-users’ opinions on the design and
this was successfully achieved even without statistical significance.

6.2.1 Focus group methods

First, subjects received an oral introduction to the prototype, including an overview of its
features and design, and a demonstration of the adjustments. Originally, the clinicians were to fit
the wheelchair to each of the children. However, this did not occur due to unexpected difficulties
with the children in the group. For instance, one child was too heavy for the prototype,
approximately 130 pounds; and the parent of another child decided that she did not want her
child to transfer to and try the prototype. Consequently, instead of actually fitting the chair to the
child, clinicians and parents were asked to make a series of adjustments to the prototype
including adjustments to the seat depth, back rest angle, leg rest angle, footrest angle, and
changing the wheels from 12.5" attendant wheels to 20" push-rim wheels. Thus, clinicians and
parents still had extensive exposure to the prototype as these adjustments were made, and this
experience served as the basis for their evaluations.
Parents and clinicians were then asked to complete a questionnaire comprised of a series
of Likert scales assessing their evaluation of the folding mechanism, ease of transport, added
features and components, and the aesthetic aspects of the chair. An open-ended question
provided participants with the opportunity to list any recommended changes they may have. A
large majority (e.g., 70%-80%) of positive responses (“agree” or “strongly agree”) on the Likert
scales (after reversing scales where appropriate) for each aspect of the evaluation provided initial
evidence that the prototype met the performance goals. The focus groups took approximately
two hours each.
Although it was hoped that the children would provide evaluative feedback, due to
cognitive limitations and the fact that the children did not sit in the prototype, this did not occur.
Instead, parents and clinicians completed the evaluation questionnaire (one designed specifically

35
for parents and one for clinicians) after making adjustments to the chair. Then, after completing
the written questionnaire, they participated in an open discussion based on the questionnaire.
Audio of the discussion was recorded.
The questionnaire consisted of close-ended questions on 5-point scales addressing ease of
use, appearance, and features such as adjustability. Open-ended questions probed subjects’
thoughts and ideas on 5 topics: Tilt Mechanism, Seating, Appearance, Overall Function, and
Overall Quality. Below is a sample close-ended question, see Appendix A for the full
questionnaires.

I would be able to transport the PALM wheelchair in my vehicle.

I strongly agree I agree I feel neutral I disagree I strongly disagree

Please comment_____________________________________________________________

Figure 22: Sample close-ended question

6.2.2 Results

The responses to the questionnaire are summarized in Tables 4 and 5. Table 4 shows the
average ratings both clinicians and parents gave on key close-ended questions. Comments from
the open-ended questions were categorized and the frequencies of comments tallied. Table 5
shows all comments that occurred 3 or more times (i.e., at least 23% or more of the subjects
made the same or similar comment).
Parents’ and clinicians’ ratings regarding the ease of using the tilt mechanism, switching
wheels, and learning to use the wheelchair were very positive. During discussion, clinicians
stated specific benefits of the US PALM tilt mechanism over similar products. These comments
included the use of only one handle release for the tilt as opposed to two, the shorter wheel base

36
length and the tipping stability. Clinicians agreed that the ability to easily switch wheel type
would be beneficial to a child as long as the wheelchair weight was low enough that he would be
able to push it.

Table 4: End-users' evaluations of the US PALM

Question Clinician Parent

1= strongly agree; 5= strongly disagree
1) Tilt mechanism operated smoothly 1.4 n=10 1.7 n=3
2) Easy to switch from attendant-style to push-rim wheels 1.7 n=9 1.5 n=3
3) Would be transportable in passenger vehicle 3.8 n=9 1.7 n=2
4) Learning to use chair is easy 1.7 n=10 2.5 n=3
5) Wheelchair has pleasing appearance 2.7 n=10 2.3 n=3
6) Appears high quality 2.2 n=10 3 n=3
7) Enough adjustability to accommodate propulsion needs 2.7 n=7 4.5 n=2
8) Enough adjustability to accommodate seating needs 2.25 n=8 4.5 n=2
* The means reported are based on slightly varying Ns because some subjects failed to answer
some questions.

37
Table 5: End-users' comments about the US PALM (N=13)

Comment Frequency
Should be more transportable in a car 6
Needs split footplate option 6
Chair needs a quick fold mechanism 5
More seating components 4
Detachable footrests 4
Use fewer Allen wrenches to make adjustments 4
Colors 3
Needs padded armrests 3
Should be lighter weight 3
Needs more quick releases 3
Needs a quick recline mechanism 3

Parents’ ratings on adjustability seemed less favorable because of specific issues with
their children. Responses to the open-ended questions and comments during the discussion
revealed that, in one case, the child frequently used a power add-on unit for her manual
wheelchair and because the US PALM did not have this feature, it received a low rating. In the
other two cases, the children were unable to self-propel under any circumstances, therefore the
parents stated that they did not feel the feature was necessary. Parents explained that their
unfavorable ratings of seating adjustability stemmed from the fact that the chair did not have
enough additional seating supports such as thigh abductors and a headrest attached to it. They
also stated their opinion would change if these items were added. This was not surprising
because little design thought was put towards the seating system. The majority of the design
effort in this phase was directed to the overall concept of the chair and the seating was left as a
simple planar seat.
The prototype required the removal of screws in order to break down for transport.
Because it is not a quick procedure, clinicians gave less favorable ratings in terms of
transportability. Interestingly though, the parents gave the chair high ratings in this area, because

38
they all owned vans which could easily transport the chair. Both clinicians and parents said that
they would have rated the chair higher on appearance had the prototype been painted a bright
color and had the chair been made to look more child-like or like a stroller.
Not surprisingly, subjects’ open-ended comments summarized in Table 5 closely parallel
their responses to the close-ended questions. The most frequent open-ended comments centered
on transportability, ease of folding, and the need for additional footplate and seating components.
The final PALM work attempted to address some of these comments.

6.3 TESTING

6.3.1 Method

ANSI/RESNA testing was carried out at the

Assistive Technology Evaluation Laboratory at
the Human Engineering Research Laboratories
(HERL). For the tests it was equipped with
standard 12.5” attendant-style rear wheels with
injection molded wheels and “flat-free” solid tire
inserts and 6” by 1” caster wheels. Two of parts of
the ANSI/RESNA testing (Parts 01 & 08) are

particularly relevant to the safety and operation of

the wheelchair.39 Part 01 is a determination of Figure 23: Static stability test of PALM v2
static stability (Figure 23) and involves placing
an appropriate-sized wheelchair test dummy in the
wheelchair and testing to see whether or not it will tip backward on an 8% slope. A failure is
seen when the wheelchair becomes unstable at the 8% slope. The least stable and most stable
axle positions were tested for this test. For the purpose of simulating a child’s weight, the PALM
wheelchair was tested with the lightest test dummy- 50 kilograms.

39
 Part 08 is a determination of static
strength, impact strength, and fatigue strength
(i.e., double-drum testing, and curb drop testing).
39
In the static strength tests, parts of the
wheelchair (e.g., footrests, anti-tipper devices,
etc.) are subjected to a constant force required in
the standards. Impact strength testing includes
applying dynamic forces to the wheels, casters,
hand-rims, armrests, backrests, and seat. This
testing also involves dropping an unloaded
wheelchair one meter above the ground and
dropping a dummy loaded wheelchair ten
centimeters from the ground. The double-drum
testing (Figure 24) consists of two rollers, which Figure 24: US PALM on double drum test machine
roll at a speed of 1 meter per second (one roller
turns slightly faster to avoid exciting harmonies).
The 50 kg dummy loaded wheelchair is balanced over the rollers with a swing-arm attached to
the rear axles to stabilize it while testing. Curb-drop testing uses a device that repeatedly lifts and
drops a dummy loaded wheelchair from 5 centimeters high onto a hard surface. In the past, ultra
light wheelchairs have been tested by running the double-drum test for 200,000 cycles (one
revolution of the rear roller) and the curb-drop test for 6,666 drops.40 A Class III failure is
39
permanent damage, deformation, or failure that affects the ability to use the wheelchair.
During testing, wheelchairs are monitored every 10,000 cycles and every 300 drops. Table 6
describes the tests performed and their order.

40
 Table 6: ANSI/RESNA tests performed

Test # Test Standard Description

Determination of Overall
Overall length, width, height, folded width,
1st Part 05 Dimensions, Mass, and
weight & turning radius of chair
Turning Space
Dimensional information needed to fit a chair
Determination of Seating and
2nd Part 07 to a rider. Uses standard methods of
Wheel Dimensions
measurement
Determination of Static Stability of wheelchair when resting on a
3rd Part 01
Stability sloped surface
Static, Impact, and Fatigue
4th Part 08 Strength and durability of a wheelchair.
Strength

6.3.2 Results

The PALM v2 prototype performed well in achieving the following results:

• ANSI/RESNA Static and Impact Strength Tests: Pass
• ANSI/RESNA Double-Drum Fatigue Test: Completed 200,000 cycles.
• ANSI/RESNA Curb-Drop Fatigue Test: Completed 6,666 drops.
• ANSI/RESNA Static Stability: Comparable results to competitive products.

Part 01 (static stability testing) was performed for the least and most stable positions of the
casters and rear axle positions. All tipping angles for the PALM were higher than 19°, with the
smallest tipping angle at 19.1°, which is 11.1° higher than the typical ANSI/RESNA standard
result of 8°. These results are very comparable with other competitive manual wheelchairs. 40
Part 08 testing was conducted on a pass/fail basis for the static, impact and fatigue
strengths. All of the components passed the static loading tests with a force applied of 735 N.
All impact strength tests were conducted on the prototype, and it passed all of them. The fatigue
strength tests (the double-drum and curb-drop tests) were performed last because of their

41
destructive nature. The PALM was tested on the double-drum tester and completed 200,000
cycles without failure, thus passing the test. For the curb-drop test, 6666 drops were completed
without failure, thus passing that test as well. The prototype was not tested to failure on these
two tests.

6.3.2.1 Weight and dimensions

The tested prototype weighed 32 lbs (including attendant-style rear wheels and footrests) and had
a seat width of 13” (330.2 mm). Table 7 below contains the dimensions of the prototype when in
its standard upright position. As can be seen in the Table, the dimensions of the PALM easily
fall under the maximum dimensions allowed by ANSI/RESNA Standards.

Table 7: Dimensions of US PALM prototype

US PALM ANSI/RESNA max dimensions

Overall Length 736 mm < 1200 mm
Overall Width 533.4 mm < 700 mm
Overall Height 812.8 mm < 1090 mm
(backrest in upright position)

6.3.2.2 Comparison to test data for other wheelchairs

Fitzgerald and her colleagues used the double-drum test and the curb-drop test to examine the
fatigue life of 61 wheelchairs (25 depot chairs, 14 lightweight chairs, and 22 ultralight chairs). 41
Fifty-six percent of those wheelchairs had a Class III failure and did not pass the fatigue test
(completing both the 200,000 cycles on the double-drum and 6,666 curb-drops). The failure
rates for depot chairs, lightweight chairs, and ultralight chairs were 80%, 57%, and 27%,
respectively. In passing these two tests, the PALM’s performance exceeded that of the vast
majority of depot chairs, a majority of lightweight chairs, and 20% of its ultralight counterparts.
Because the PALM was built in a machine shop using prototyping materials and
methods, the test results do not necessarily correlate to that of an equivalent but mass-produced

42
product made with factory materials and methods. For example, injection molded Polyethelene
parts will not have the same structural strength as CNC machined Delrin. Nonetheless, it was
useful to test the prototype. Durability and fatigue data can be a useful tool during an iterative
design and prototyping process and not simply at the end stage of product development when a
design is ready for market.

6.4 U.S. PHASE CONCLUSION

The results of the US PALM Phase were a strong initial indication of the viability, practicality,
and value of the US PALM. Although the design criteria were met, ANSI/RESNA test results
were outstanding and the focus group evaluations were mostly positive, they also included
invaluable feedback regarding remaining shortcomings of the design. This set the stage for the
final Phase in which improvements were made to bring the concept one step further towards
product realization.

43
 7.0 FINAL DESIGN AND DEVELOPMENT PHASE

Feedback from the focus groups conducted in the US PALM phase provided invaluable
information regarding where improvements in the design could be made. This feedback served as
the basis for the Final PALM design criteria. The result of the final Phase is an “alpha” or
“presentation” prototype that is easier to use, more aesthetically pleasing, has better functionality
and safety features and is one step closer to a pre-production prototype.

7.1 FINAL PHASE DESIGN

The two innovations which distinguish the PALM from other pediatric wheelchairs currently
available in the U.S. market are a new center-of-gravity tilt-in-space mechanism and a modular
design using plastic injection molded nodes to join the chair. These features were conceived in
the India phase and remained essential to the final phase. Another difference between the Final
PALM and existing products is the use of color on the wheelchair. Although it is a simple aspect
of the design, color aids in making the wheelchair seem less institutional, medical and disabling.
It appears more like a stroller and thereby more appealing. Aesthetics is a critical element of
pediatric wheelchair design. Although a wheelchair may be highly functional and beneficial to a
child, if it is institutional-looking or unappealing aesthetically, it is less likely to be purchased or
prescribed. Improvements to the design in this phase were made based on the US PALM focus
group comments, ANSI/RESNA testing and changes to prototyping methods.

44
7.1.1 Final Phase design objectives

Final Phase design objectives were to:

1. Improve ease of folding mechanism
2. Reduce weight
3. Improve ease of use
4. Improve comfort
5. Improve seating system
6. Consider design for
manufacturability
7. Improve aesthetics

Figure 25: Concept drawing for final PALM

7.1.2 Design improvements

During the US PALM focus groups, specific features and components were identified as worth
including to improve ease of use for caregivers and children, comfort, and therapeutic benefits of
the chair; tool free adjustments, five degrees of anterior tilt in the seat for easier transfers, split
footplate to accommodate leg length discrepancies, side guards, ergonomic push handles, padded
armrests, an accessory bag and a removable seat that unlocks from the base. The plastic
components were designed for simple one-step CNC milling with Delrin. This required blocky
shapes (Figure 27). The Final PALM prototype was designed as an industrial design prototype,
the materials and forms are closer to those used for mass-manufactured products, look more
finished and are further optimized for lighter weight. (Figure 26)

45
 Figure 26: SLA plastic components, final PALM phase

Figure 27: Machined Delrin plastic components, US PALM phase

7.1.2.1 Objective 1: Improve ease of folding mechanism

To break the US PALM prototype down for transport, several screws had to be removed and
tools used. In the US PALM focus groups, clinicians clearly noted this drawback. To rectify
this, a tool-free break down process was achieved through 1) the use of knobs, 2) the design of
an improved folding mechanism and 3) a removable seat. (Figure 28, 29) The removable seat
allows the wheelchair to be more easily transported in a vehicle and potentially the seat could be
used on other bases in different environments. A chair that breaks down into two pieces allows
the chair to be more easily transportable, because the separate pieces are more manageable
separately than lifting the whole chair in one piece. The assembled chair weight is 28 pounds.

46
Figure 29: Concept drawing of removable seat

Folded dimensions:
L=26”, W=23”, H=18.5
Total chair weight= 28 lbs
Figure 28: Process of dismantling Final PALM for transport

47
 Figure 30: Close-ups of clamp releasing seat assembly

The two clamps at the rear of the seat are unscrewed and the clamps released (figure 30).
Then the seat is pushed forward to release the tube plugs (figure 31). The seat can then be lifted
off the base. Other methods could be used for releasing the seat which might be quicker. This is a
strong and simple mechanism however it is a four-step process. The next design phase should
explore the possibilities of a one or two step quick-release mechanism. In order to make it even
more transportable, the leg rests could have a quick-release folding mechanism allowing them to
fold under the seat.

48
Figure 31: Image showing seat pushed forward to release tubes from locking plugs.

49
 7.1.2.2 Objective 2: Reduce weight
This was achieved by minimizing the amount of tubing and by streamlining the design of the
plastic components. The US PALM weighed 32 pounds when fully assembled including wheels
and footrest. Compared to currently available pediatric tilt-in-space wheelchairs, this was on the
light side. However, it was still not ideal. The Final PALM weighs 28 pounds. Weight will
likely be reduced further when the design is optimized for mass production; however, addition of
accessories will add weight.

Table 8: Final PALM dimensions

Final PALM ANSI/RESNA max dimensions

Overall Length (from push handle 812 mm < 1200 mm
bracket to foot rest)
Overall Width 584 mm < 700 mm
Overall Height 965 mm < 1090 mm
(floor to push handle bracket)

7.1.2.3 Objective 3: Improve ease of use

During the US PALM focus groups, features and components were identified as worth
incorporating to improve ease of use, comfort, and therapeutic benefits of the wheelchair. The
following features were incorporated into the design:
• Small amount of anterior tilt in the seat to allow for easier transfers
• Split footplate option in addition to the single footplate to accommodate leg length
discrepancies that are often present within the target population
• Side guards and ergonomic push handles
• Self-contained removable seating system

The following features were noted as important in the US Phase focus groups; however, they
were not incorporated into this final prototype:
• Removable leg rests for easier transfers
• An adjustable length split seat pan to further accommodate this need.

50
 • Adjustable angle armrests to accommodate the change in trunk angle when the back rest
is reclined.
• Quick release caster to allow for a larger caster wheel to be used outdoors.
• Activity tray
• Platform for ventilator
• IV pole
• Hooks to carry things during transport
• Accommodation of a power add-on unit
• Different size chair for larger child that would incorporate 2 MechloksTM and larger
wheels and would be tested to a higher weight capacity.

Key design features in the final phase which improve ease of use for the caregiver are: 1)
Velcro removable and washable upholstery (Figure 32), 2) ergonomic push handles, 3)
removable seating system, and 4) wider caster spacing for easier transfers.

The final PALM upholstery is an aesthetic model and could not actually be used. However, it is a
key to giving the look and feel of a final product and has a couple features which should be
included in any final design. First, it is easily removable and washable and second, it is colorful.
The next iteration should consist of a more durable prototype with foam wrapping entirely
around each sheet metal component and more Velcro or snaps to firmly hold the fabric to the
metal. The upholstery should allow for a small range of adjustability, however, it should be made
available in many sizes and ordered based on a child’s measurements. The majority of the
adjustability is in the seat frame. Likely, during the life of the wheelchair, the upholstery should
be replaced when it is worn or excessively soiled. As obvious as this feature seems to therapists
and parents, many pediatric wheelchairs have non-removable upholstery that can only be cleaned
with a hose or sponge.

51
Figure 32: Upholstery adheres to seat frame with Velcro, is removable and washable.

Figure 33: Images of backrest with upholstery

52
An adjustable handle angle
affords an ergonomic pushing
position. A common feature in
most strollers and some
wheelchairs on the market, it is a
key feature to include in a care-
giver friendly design.
Wider caster spacing has
two main benefits; 1) wider caster
spacing allows for easier transfers
close to furniture, and 2) less
Figure 34: Adjustable handle angle
interference with the foot rests.
When the US PALM leg rest angle
was at 90 degrees, the leg rest
interfered with the rotation of the casters. This is often a problem in wheelchair design and was
greatly reduced with the wider caster spacing. With the casters in a trailing position, the width of
the front of the chair is 23 inches. This is still narrow enough to fit through doorways.
Wheelchairs typically do not exceed a 25 inch width. The wide caster spacing also gives the
wheelchair a stable base. This improves maneuverability and safety on rough terrain.

7.1.2.4 Objective 4: Improve comfort

Comfort for the rider was addressed through the
design of the seat, range of adjustability, and
upholstery. Comfort for the caregiver was addressed
through the design of ergonomic push handles,
transportability and the knob design. Larger casters
were used on the final prototype to improve its rolling
capability over rough terrain and to increase shock
absorption.
Figure 35: Ergonomic knob design

53
 7.1.2.5 Objective 5: Improve seating system
The seat design on the US PALM prototype was not fully evaluated, thus it remained
simple planar seating in the prototype. The final PALM seating design is in its first full-scale
iteration. Therefore it is conceptual in nature. In the final phase, the seat was designed as a
contoured modular unit with adjustability in seat depth, seat back angle, seat back width, lateral
side support position, seat back height, and independent foot rest length and angle. Figure 42
illustrates the points of adjustability on the prototype. Figure 43 illustrates the mechanism used
for angle adjustments. The handle bar adjustment point uses a standard OEM quick button
adjustment mechanism. Figure 40 shows all the components built for the final PALM prototype.
Additional components such as adjustable height armrests, larger lateral supports, different
headrests, pommel and seat belt would need to be available in order to fully evaluate the seating
system with a child.

Figure 36: Seat moving through range of tilt and recline

Figure 37: CAD concept model of tilting seat

54
 8 10

6.5”

14 15.5”

9.5”

10 13” 4.5

Figure 38: Images of backrest showing smallest, medium and largest configuration.

Figure 39: Images of seating components with and without upholstery

55
 Figure 40: Close-up of adjustment mechanism used
at back rest recline and leg rest angle points.

The US PALM model had some adjustments not present in the Final PALM. The seat to
floor height adjustment was removed. This adjustment was removed to simplify the
manufacturing process and reduce points of weakness in the frame. In addition, the seat to floor
height is at a good level. It is lower than most pediatric tilt-in-space chairs. The low seat-to-floor
height in combination with 10 degrees anterior tilt allows a child to more easily perform a stand-
pivot transfer if they are able. In addition, the height is sufficient for children to be at eye-level
with peers and fit under tables for activities. The low center of gravity also helps the chair to
remain more stable on rough terrain and slopes.
Plantar/dorsiflexion angle adjustment was removed simply to improve the ease of
manufacturing. This adjustment should be added in the next iteration. Adjustable height armrests
should also be added. The side supports on the final PALM prototype have a slot built in that
could accommodate an adjustable arm pad. Figure 42 illustrates the points of adjustability on the
prototype. The circles indicate points of rotation and arrows indicate linear adjustments. The tilt
geometry had to be redesigned again for the final PALM. Although the US PALM tilt worked
smoothly and maintained a stable CoG, the rear linkage point was too low and the pusher could
kick the bar while pushing the chair from behind. To remedy this, the rear linkage arm was
shortened and the pivot point placed closer to the seat. With this change, the ergonomic push
handles and the large soft wheels, the final PALM is much more comfortable to push.

56
 Figure 41: Back reclined

Figure 42: Side view of final PALM with upholstery removed to

show underlying structure. Illustrates points of adjustability

7.1.2.6 Objective 5: Improve aesthetics

Although focus group participants said the PALM looked “sturdy,” “sleek” and “high-tech,” they
also noted that the chair needed to look “more child-like” and “colorful” and “more fun.” One
focus group discussion centered on the aesthetic of the stroller and the reluctance parents often
feel when it is time to transition their child from a stroller to a wheelchair that is more capable of
meeting their seating needs. Clinicians commented that parents tended to see strollers “cute”
whereas they tended to see wheelchairs as “scary.” This often leads parents to keep their child in
a stroller long after the functional needs of the child have surpassed what a stroller could offer.
The Final PALM attempts to mimic as much of the pleasing “stroller aesthetics” as
possible while maintaining all the features and functions of the earlier version. This was
accomplished by streamlining the shapes, using color, and creating a “visual language” amongst

57
all the wheelchair’s components. The use of SLA rapid prototyping allowed the parts to be made
much more streamlined allowing the design to look and feel much more like a final product.

Figure 43: Final PALM prototype

58
 8.0 FINAL PHASE FOCUS GROUP

The final PALM focus group followed the same format and used the same questionnaire as the
US Phase. The goal was to evaluate the design features of the final PALM prototype.
The responses to the questionnaire are summarized in Tables 9 and 10. Table 9 shows
the average ratings both clinicians and parents gave on key close-ended questions. Comments
from the open-ended questions were categorized and the frequencies of comments tallied. Table
10 shows all comments that occurred 2 or more times (i.e., at least 22% or more of the subjects
made the same or similar comment). Table 11 compares averages of responses to the close-
ended questions between the U.S. PALM phase and the Final phase.
As in the U.S. PALM phase, parents’ and clinicians’ ratings regarding the ease of using
the tilt mechanism and learning to use the wheelchair were very positive. Large self-propulsion
wheels were not used during the focus group, therefore there were no comments regarding ease
of switching between wheels.
Responses on all other points; appearance, quality, propulsion and seating were improved
from the earlier phase. The only significant change between the two focus groups is the response
to the question of attractiveness of the wheelchair which showed a significant improvement with
a p-value of 0.008 using the mann-whitney test. Mann-whitney was used because the sample size
is so small. In future work, two larger sized focus groups should be held with the same
wheelchair, and compare between them in order to validate the questionnaire.
One interesting finding from the focus group is that transportability was more of an issue
in the second group. In the first group, all of the parents stated that they owned vans; therefore
transportation of the wheelchair would not be difficult, even though it couldn’t be dismantled
without the use of tools. The Final PALM focus group parents were much more concerned about
transportability in a car trunk and thought the base needed to collapse into a more compact size
for easy transportation in a trunk. During the focus group, the Final PALM collapsibility was

59
demonstrated prompting a substantial discussion on the issue of collapsibility. Because the
earlier model was not collapsible, no such discussion took place. It is possible that the focus of
the discussions during the focus groups affected the features on which participants decided to
focus their critique, thereby skewing the questionnaire comments towards different design
features.
The most useful aspect of the focus group was the discussion and the open-ended
comments given in the questionnaire (Table 10), because these formats allow participants to
offer their own creative ideas and nuanced opinions. In this way, qualitative research is highly
useful to the design process. The comments should drive the next series of design refinements
made to the PALM for the Beta prototyping stage.
Although this focus group sample size is quite small and the data is qualitative in nature,
the focus group did provide useful feedback on the design. Focus groups are by nature subjective
and therefore are used to stimulate new ideas and gauge user opinion on a new design rather than
as hard facts regarding a design’s quality and usefulness. In conclusion, although there are still
improvements to be made, the Final PALM design is a significant improvement over the
previous prototype and holds promise as a potential product.

60
Table 9: End-users’ evaluations of the final PALM

Question
Clinician Parent
(1= strongly agree; 5= strongly disagree)
1) Tilt mechanism operated smoothly
1.14 n=7 2 n=2

2) Would be transportable in passenger vehicle 2.83 n=6 4 n=2

3) Learning to use chair is easy 2 n=7 2 n=2
4) Wheelchair has pleasing appearance 1.71 n=7 2 n=2
5) Appears high quality 2.14 n=7 2.5 n=2
6) Enough adjustability to accommodate propulsion needs 3.33 n=3 2 n=2
7) Enough adjustability to accommodate seating needs 2 n=6 2.5 n=2

* (clinician N=7, parent N=2) the means reported are based on slightly varying Ns because some
subjects failed to answer some questions.

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Table 10: End-users' comments about the PALM Phase II v3 (N=9)

Comment Frequency
Should be more transportable in a car 9
Needs footrests that move out of the way 7
Needs stronger seat components 4
Positive comments about tilt 4
Upholstery should cover edges of components 3
Needs secure non-removable parts (like knobs) 3
Needs more anterior tilt 2
May need anti-tippers 2
May need 22”wheels instead of 20” 2
Needs footplate angle adjustment 2
Needs more secure upholstery 2
Seating is hard to adjust 2

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Table 11: Comparison between average close-ended responses from US PALM and Final PALM

Question
US Final change
(1= strongly agree; 5= strongly disagree)
Tilt mechanism operated smoothly 1.55 n=13 1.57 n=9 +0.02

Would be transportable in passenger vehicle 2.75 n=12 3.42 n=8 +0.67

Learning to use chair is easy 2.1 n=11 2 n=9 -0.1

Wheelchair has pleasing appearance 2.5 n=13 1.86 n=9 -0.64

Appears high quality 2.6 n=13 2.32 n=9 -0.28

Enough adjustability to accommodate propulsion needs 3.6 n=9 2.67 n=5 -0.93

Enough adjustability to accommodate seating needs 3.38 n=10 2.25 n=8 -1.13

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 9.0 NEXT STEPS

The final PALM prototype is a demonstration model. In order to bring the design to the next
level, optimization and refinement is needed. There are four levels of work that need to be done;
1) design changes for Beta prototype, 2) testing for Beta prototype, 3) steps to take for pre-
production prototype and 4) user trials.

9.1 DESIGN CHANGES FOR BETA PROTOTYPE

Issues raised in the focus group should be assessed for their importance and feasibility.
For example, using captive screws, rather than the removable knobs and bolts at the pivot
adjustment points, is a simple solution to a relatively important problem. Additional components
such as lap tray, seat belt and sunshade will need to be designed as well. The feasibility of these
changes needs to be addressed before the chair is finalized in a Beta-prototype.

The design issues that must be addressed are in two categories below, most critical and less
critical.

9.1.1 Critical changes

• Durability of seating components

The seat components are in their first iteration, therefore, testing does not make sense
at this time. Some changes should be made prior to testing. For example, the seat

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 back panels should be machined from 0.125” aluminum, because there is too much
flex in the 0.0625” and the pieces are unlikely to withstand testing. In order to test the
seat, the 50 kg test dummy may need to be adapted. Because the seat back is
contoured, the large flat back of the current test dummy may not appropriately load
the backrest. The 50 kg dummy used in the US PALM tests was made by removing
weight from the adult sized dummy; therefore its dimensions did not change except in
lower leg length. This should be addressed prior to testing.

• Seat back

The seat attachment bracket holding the seat back to the seat bottom plate should be
reinforced. Upon completion of the prototype, it seems that the attachment of those
two components may not be rigid enough. It makes sense to address this prior to
testing.

• Push handle brace

The push handles were braced together via two brackets and a tube. This would be
made stronger if the brace were a welded bent tube rather than a bolted bracket. This
was not done in the final prototype simply due to time and resource limitations. This
is a fairly simple change that would add needed strength to the push handle assembly.

• Brakes

Brakes need to be added. An OEM stroller brake may be sufficient. The scissor-type
wheelchair brake should not be used, but rather one that the caregiver can operated
with one foot, braking both rear wheels simultaneously, or a handle and cable
actuated brake.

• Flip-up foot plates

This feature was suggested many times during the focus group and was deemed
highly important for the ease of transfers. A split footplate is necessary to
accommodate leg length discrepancies, and it could be made interlocking to add
strength to the footplates.
• Captive screws and knobs replace removable knobs at pivot points

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9.1.2 Less-critical changes

• Seat removal system; ease of use

Seat removal is currently a 4 step process: unscrew first clamp, unscrew second
clamp, push seat forward releasing plugs, lift seat off rotating slightly to allow
clearance between push handles. To improve usability this process should ideally be
simplified to a one or two step process.

• Quick release leg rest

A quick release mechanism should be placed at the leg rest pivot joint. When the seat
is removed, the leg rests should be able to quickly fold up under the seat bottom plate.
This will improve transportability.

• Quick release push handle folding mechanism

The push handle folding could be made easier if a quick release replaced the current
knob and screw mechanism. The OEM quick release button used at the push handle
angle adjustment point could be used for the handle folding as well. However, the
strength of this part should be tested with cyclic loading. Although this mechanism is
simple and quick, it may not be strong enough to withstand the forces placed on the
push handle.

• Push handle folding

The overall dimensions of the base could be reduced for transportability by

approximately 6 inches, if the push handle adjustment bracket and pivot point were
placed closer to the seat.

• Upholstery

Because the upholstery was simply an aesthetic model, it is inappropriate for testing.
The material used is a polyester ultra-suede material. It was chosen for its look and
feel and because it was available at the local fabric store. A fabric should be chosen
with the appropriate durability, breath ability and wash ability characteristics. It is

66
 unlikely that this fabric could be found locally, but rather would be available through
industrial supply catalogs.

• Modify rear plastic joint geometry in order to use 22” self-propel wheels

• Quick release back rest adjustment

This should be adjustable via quick release mechanism or a one-handed knob type
adjustment as opposed to the current configuration that requires a two-handed
operation on both the left and right sides.
• Accessories
Addition of a sun/rain shade, lap tray, seat belt and additional seating components
will be critical to the success of the usability of the PALM during in-home user trials.

9.2 TESTING FOR BETA PROTOTYPE

Once the design changes have been made, the plastic components can be made using the
selective laser sintering (SLS) process and an appropriate plastic. This will yield high strength
parts with much less effort than would be required to re-design the parts for molding even with a
soft-tooled process. A second prototype with SLS parts and the aforementioned design changes
should be tested with a modified 50 kg test dummy. The test dummy should be dimensioned
38
based on the anthropometric data used to develop the wheelchair design. It may be more
appropriate to use a pediatric crash test dummy for this test, rather than the ISO test dummy used
to load wheelchairs during the ANSI/RESNA durability and fatigue tests. The wheelchair push
handles should be tested with a cyclic loading test machine. Information on performing this test
may be available through stroller testing standards. Although this test is a variation on the
ANSI/RESNA standards, the durability of the plastic quick-release parts at the push handles
needs to be tested and the single load applied during the ANSI/RESNA test may not be enough
to verify durability.

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 9.3 USER TRIALS

Multiple Beta prototypes could be manufactured and used for in-home user trials. This would be
a useful step prior to pre-production prototyping because more information can be gathered than
is possible in a focus group. Data logging devices could be used to monitor the wheelchair usage
and distance traveled to validate the design.42 Data logging devices can also be used to monitor
the use of tilt-in-space seating. Studies with the Beta prototype should include comparison with
other comparable products and usability studies. Blinded comparisons could be done between a
beta prototype and commercial products

9.4 STEPS FOR PRE-PRODUCTION PROTOTYPE

Once the Beta prototype design and testing is completed, a pre-production prototype must be
developed. This will require design optimization for injection molding in order to make the
plastic components lighter weight and durable. The ABS-like resin used in the SLA process
requires 0.2” wall thicknesses and can accommodate large solid sections. Injection molding
typically requires wall thicknesses 0.1” or less and consistent thickness throughout the whole
part. A suitable plastic also must be chosen based on material properties and cost. This can be
outsourced at reasonable cost to a rapid injection molding company. Once the PALM has been
outfitted with these parts, ANSI/RESNA testing must be performed again.
In addition, the design of some components will need to be modified in order to minimize
the number of different parts needed on the chair. Making many different types of plastic parts
will be necessary when injection molding, due to tooling costs.

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 9.5 FUTURE DESIGNS

Below is a list of some future concepts that could be incorporated into the design or stem from
this project. These would likely be done after the PALM has been successfully marketed.

• The feasibility of a power seat tilt and/or recline should be investigated. This could be a
very useful feature for children to gain some independence in their seating.

• Because pediatric tilt-in-space wheelchair users often ride in school buses, the prototype
may need to be tested for crash worthiness and the frame will need to be assessed for a
four-point tie down system.

• Ideally, this design would weigh less than 25 pounds. In order to achieve this, carbon
fiber could be used for the seat components instead of the machined aluminum sheet used
in the Final PALM prototype.

• Retrofitting the chair with power assist wheels

• Scaling the seating system for adult use

• Development of other wheelchair designs using the same injection molded components

• Technology transfer back to India where the project began

Because the focus groups were immensely helpful in the design of the PALM, future
product development projects of this type should incorporate user input even earlier in the design
process. User input at the initial concept stage may have proven useful to the design team.
Although it is challenging to hold focus groups when only conceptual models are available,
users’ ideas can be tapped via other methods in a charette format or simply by critiquing existing
6,43
products in order to reveal design opportunities. These methods can help designers avoid
pitfalls and uncover new ideas.

69
 10.0 DISCUSSION

As a versatile, affordable tilt-in-space pediatric wheelchair, the PALM could fill a need
not currently met by existing pediatric wheelchairs. In addition to enriching the U.S. pediatric
wheelchair market, the PALM could also benefit the international wheelchair market,
particularly in developing countries where there is a great need for high-quality low-cost
wheelchairs. The PALM was designed to be versatile enough to be manufactured using lower
cost materials in developing countries and higher end materials in developed countries, all the
while using the same injection molded components. Use of the injection molded components
would further reduce cost and increase manufacturing precision by eliminating the need for weld
jigs.
Design for developing countries is often undertaken as a humanitarian endeavor.
However, the India wheelchair project concepts were developed that are both innovative and
applicable in the U.S. market. This raises the question of whether the product development
process used for assistive devices by large U.S. manufacturers somehow inhibits innovation. Is it
possible that the cost and contextual constraint problems of the developing country inspire a
different level of design thinking? Products developed for the developing world context under
the umbrella of humanitarian and charitable causes could prove to be useful elsewhere in the
world. In fact, the success of these products in the U.S. market could aid in funding projects in
developing countries for which the ideas were first conceived. It is hoped that the design
developments made during the U.S. phases of this project will be transferable back to the Indian
context and allow that project to continue, since that is where the vast need remains.
There are inspiring examples of projects in which a consumer product in the U.S. market
is used to fund a conjoining humanitarian cause. One case of this is the iBOT mobility system, a
high-end power wheelchair for people with mobility disabilities. The Segway personal
transporter, designed by the same company for use by able-bodied users and sharing the same
core technology as the iBOT, fits into a much larger market but utilizes many of the same

70
components as the iBOT. The Segway subsidizes the manufacture of the iBOT which would
otherwise be unrealistically expensive in any context. Another example is Kids Up, Inc. a for-
profit company which designs pediatric wheelchairs for the U.S. market and distributes through
Sunrise Medical. This company supports a non-profit organization, ROC Wheels, that designs,
manufactures and provides pediatric wheelchairs in developing countries.
Although the need for high quality pediatric wheelchairs is much more extreme in
developing countries; it is an issue that still needs attention in the U.S. and other developed
countries. It is clear that this issue is not simply one of technology and design, but also of policy,
funding, human rights, culture, and environment. In fact, the technology problem is most likely
the simplest problem to solve. The author and the team involved chose to address the design
aspects of the problem but acknowledge the great need for attention to the complex societal and
political issues that allow such problems to persist.

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 APPENDIX A. FOCUS GROUP QUESTIONNAIRES

The following questionnaires were developed for the PALM design project. Three
questionnaires, one each for child, parent, and clinician, are included. Even though the child’s
questionnaire was never used during a focus group, due to cognitive limitations of the pediatric
participants, it is included as evidence of the work done.

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 PALM Wheelchair Questionnaire for Children

Demographic Information

Please answer the following questions about yourself.

DOB: ______/______/______
(MM) (DD) (YY)

Gender: ___ Female ___ Male

Ethnicity: ___ African -American

___ Asian -American
___ Hispanic
___ White
___ Other

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 ----------- Parents, please read directions! ----------
Directions to parent:
• If your child is able to comprehend and respond to the questions please circle or help them to
circle the response that best indicates their opinion.
• If you have any comments or your child is unable to comprehend, respond or if the question
does not apply to them, circle the symbol in the response box and comment on the line
provided.

1) I like the way the PALM wheelchair looks.

2) The PALM wheelchair looks better than my own wheelchair.

3) I would like to have the PALM wheelchair.

4) The PALM wheelchair could fit me well.

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5) I feel safe and secure in my own wheelchair.

6) I feel comfortable in my own wheelchair.

If your child was able to sit in the PALM wheelchair, please answer # 7-10 then skip ahead to 15. If
your child was unable to sit in the chair skip 7-10 and answer the remaining questions.

7) When the seat was tilted, I felt safe and secure.

8) The chair was easy for me to propel.

9) When the seat was tilted, I felt comfortable.

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10) My body feels more comfortable when I’m in my own wheelchair than the PALM
wheelchair.

Answer 11-14 only if your child was unable to sit in the PALM wheelchair.
Otherwise, please skip ahead to 15.

11) The PALM wheelchair chair looks comfortable when it is tilted.

12) The PALM wheelchair looks safe and secure when tilted.

13) The PALM wheelchair looks like it would be easy for me to self-propel.

76
14) The PALM wheelchair looks more comfortable than my own chair.

15) If you experienced pain or discomfort while seated in the PALM wheelchair draw a circle
on the picture around the areas where you felt the discomfort.

77
16) For each item, please rate the importance of the following features in regards to
pediatric wheelchairs.
1= very important
2= somewhat important
3= not very important
___ Comfort ___ Transportability

___ Appearance ___ Promotes function

___ Independent mobility ___ Improves participation

___ Adjustable tilt and/or recline ___ Fun

___ Safety ___ Growth adjustability

___ Postural support

17) Considering these 3 aspects of the PALM Wheelchair, is there anything you would
change if you could? Please explain your answer.

Tilt mechanism:

Seating:

Appearance:

Overall function:

Quality:

☺ Thank you very much for your time. ☺

We appreciate your participation!!

78
 PALM Wheelchair Questionnaire for Parents

Demographic Information

Please answer the following questions about yourself.

DOB: ______/______/______
(MM) (DD) (YY)

Gender: ___ Female ___ Male

Ethnicity: ___ African -American

___ Asian -American
___ Hispanic
___ White
___ Other

79
 Please answer the following questions about your child.

Disability: __________________________________________________

If Spinal Cord Injury, Please Indicate Level: ___________

Date of Injury or Onset of Disability: ______/______/______

(MM) (DD) (YY)

How many years has your child used a wheelchair? ____________

Was your child able to sit in the PALM Pediatric wheelchair today? Yes ___ No ___

Does your child use more than one wheelchair? Yes ___ No ___

The following questions are regarding your child’s PRIMARY wheelchair. This is the chair
in which they spend most of their time and in which they are most active.

1) How is the wheelchair propelled? (check one)

___ “Standard” self-propelled
___ Power Assist (power add-on, pushrim activated)
___ Foot propelled
___ Attendant Propelled

2) If the chair is attendant propelled, what features does it have?

___ Manual tilt ___ No features
___ Power tilt ___ Other __________________

3) What other accessories does your wheelchair have? (Check all that apply.)
___ Portable ventilator
___ Side supports
___ Power add on, such as Efix or Power Assist hubs

4) Make (brand) of your primary wheelchair: (Please look at label on your wheelchair if
unsure)
___ Action/Invacare ___ Pride
___ Everest and Jennings ___ Sunrise/Quickie
___ Kuschall ___ TiSport
___ Otto Bock ___Other: Please list_______________________
___ Permobil

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5) Model of your primary wheelchair: _______________________________________
6) Date of receipt of primary wheelchair: ______/______/______ (best guess if unknown)
(MM) (DD) (YY)

7) Is this your child’s first wheelchair? Yes ___ No ___

Please answer the following questions with your child’s “primary” wheelchair in mind

8) What types of support straps does your child use? Check those that apply or describe in
the space below, if the strap is not listed.

Backpack type X- Type shoulder

shoulder harness harness

81
9) What types of postural supports does your child use on their primary wheelchair?
Check the gray box next to the label of the postural support.

If additional supports are used which are not in the diagram. Please explain on the lines below.
_______________________________________________________________________
_______________________________________________________________________

headrest

lateral support

armrest

Rear side
seat support thigh abductor

Front side
seat support

front calf

calf

10) What type of seat cushions does your child use?

___ Custom molded ___ Honeycomb

___ Air filled cells ___ Fluid flotation
___ Standard foam ___ Varilite
___ Gel ___ Other ____________________
___ Gel and foam

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Please answer the following questions about your child’s activities.

11) On a TYPICAL DAY, how many hours is your child out of bed? _____ Hours

In a TYPICAL WEEK during the school year, how many days does your child get out of your
house and go somewhere? ____ Days

In a TYPICAL WEEK during vacation or summer break, how many days does your child get
out of your house and go somewhere? ____ Days

In your home, does your child have independent access to their sleeping area, kitchen, bathroom,
telephone, TV (or radio)? Yes ___ No ___

12) How many hours per week does your child spend in recreational activities such as sports,
exercise and playing outdoors? ________Hours

13) How many hours per week does your child spend watching TV, playing video games,
working on the computer or listening to the radio? ________ Hours

For each statement below please circle the response that best indicates your opinion If you
have any comments please circle the symbol in the response box and comment on the
line provided.

17) The tilt mechanism operated smoothly.

18) There were points during the tilting process where I could not easily work the
mechanism.

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19) It was easy to switch from attendant-wheels to push-rim-wheels.

20) I would be able to transport the PALM wheelchair in my vehicle.

21) Learning to manipulate the PALM wheelchair was easy for me.

22) The wheelchair has a pleasing appearance.

23) The chair is more attractive than most manual tilt-in-space pediatric wheelchairs I have
seen.

84
24) The PALM wheelchair looks like a high quality wheelchair.

25) The PALM wheelchair has enough adjustability to accommodate my child’s propulsion
needs.

26) The PALM wheelchair has enough adjustability to accommodate my child’s seating and
positioning needs.

27) The PALM wheelchair was comfortable for me to push.

28) I would buy PALM wheelchair for my child.

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29) I would pay between______ dollars to buy the PALM wheelchair. (Please circle the
dollar range)

$100 to $300 $300 to $600 $1200+

$600 to $900 $900 to $1200

If your child was able to sit in the chair, answer questions 30-33 and then skip ahead to 37.
If the child was not able to sit in the chair, skip 30-33 and go to question 34.

30) When the chair is tilted, my child seems comfortable.

31) When the chair is tilted, my child seems safe and secure.

32) The chair seems easy for my child to propel.

33) My child seems to more comfortable when sitting in this wheelchair than in his/her own
chair.

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Please go to question 37.

34) The chair looks safe and secure when it is tilted.

35) The chair looks easy for a child to self-propel.

36) The chair looks more comfortable than my child’s own chair.

37) For each item, please rate the importance of the following features in regards to pediatric
wheelchairs
1= very important
2= somewhat important
3= not very important

___ Comfort ___ Transportability

___ Appearance ___ Promotes function
___ Independent mobility ___ Improves participation
___ Adjustable tilt and/or recline ___ Fun
___ Safety ___ Growth adjustability
___ Postural support

87
38) Considering these 3 aspects of the PALM Wheelchair, is there anything you would
change if you could? Explain your answer.

Tilt mechanism:

Seating:

Appearance:

Overall function:

Quality:

☺ Thank you very much for your time. ☺

We appreciate your participation!!

88
 PALM Wheelchair Questionnaire for Clinicians

Demographic Information

Please answer the following questions about yourself.

DOB: ______/______/______
(MM) (DD) (YY)

Gender: ___ Female ___ Male

Ethnicity: ___ African -American

___ Asian -American
___ Hispanic
___ White
___ Other

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1) Rate your knowledge on each of the following topics: record the appropriate
number in the box.
1= very knowledgeable
2= some knowledge
3= no knowledge

___ Clinical needs of pediatric wheelchair users

___ Clinical needs of wheelchair users in general
___ Technical aspects of wheelchairs in general
___ Technical aspects of pediatric wheelchairs specifically

2) What is your professional background? Check all that apply

___ Medical Doctor

___ Physical Therapist
___ Occupational Therapist
___ Physical Therapist
___ Rehabilitation Engineer
___ Rehabilitation Tech Supplier
___ Rehabilitation Counselor
___ Other ________________________ (describe)

3) By what means have you gained most of your knowledge of pediatric

wheelchairs? Check all that apply

___ Clinical Experience

___ Coursework and/or non-clinical training
___ Engineering experience
___ Journals, books, websites, professional publications

90
For each statement below please circle the response that best indicates your opinion. If you
have any comments please circle the symbol in the response box and comment on
the line provided.

4) The tilt mechanism operated smoothly.

5) There were points during the tilting process where I could not easily work the
mechanism.

6) It was easy to switch from attendant-wheels to push rim-wheels.

7) The PALM wheelchair was easy to adjust in order to fit the child.

91
8) The PALM wheelchair could be transportable in a passenger vehicle.

9) Teaching someone else how to use the PALM wheelchair will be easy to do.

10) The PALM wheelchair has a pleasing appearance.

11) The PALM wheelchair is more attractive than most manual tilt-in-space wheelchairs that
I have seen.

12) The PALM wheelchair looks like a high quality product.

92
13) When the chair is tilted, the child seems comfortable.

14) When the chair is tilted, the child seems to be safe and secure.

15) The chair has enough adjustability to accommodate the child’s propulsion needs

16) The chair has enough adjustability to accommodate the child’s seating and positioning
needs

17) The chair is easy for a child, who is able, to self-propel.

93
18) Please rate the importance for each of the following features in regards to pediatric
wheelchairs.
1= very important
2= somewhat important
3= not very important
___ Comfort ___ Transportability
___ Appearance ___ Promotes function
___ Independent mobility ___ Improves participation
___ Adjustable tilt and/or recline ___ Fun
___ Safety ___ Growth adjustability
___ Postural support

19) Considering the following 3 aspects of the PALM wheelchair, is there anything you
would change if you could? Please explain your answer.

Tilt mechanism:

Seating:

Appearance:

Overall Function:

Quality:

Other:

☺ Thank you very much for your time. ☺

We appreciate your participation!!

94
 APPENDIX B. FOCUS GROUP TRANSCRIPT

The following discussion transcript was recorded during a focus group dated May 2007
as part of the U.S. PALM work. Three discussions were recorded in all, the most recent focus
group is included here as evidence of the work.

95
PALM focus group discussion transcription
Monday May 31, 2007

C= focus group coordinator speaking

S= Clinician subject speaking
P= Parent subject speaking

S a pin or something like that so that if it does come off you have a pretty good idea where
it goes
S if the foot rests adjusted separately I think it would help
C different angle adjustments?
S you can adjust the height right? But the angle you can’t?
C not independently
S so I think independently, the angle adjustment would be good
C and I’d like to have this mechanism here as well so that this is a quick release
S I’m all for a headrest that doesn’t poke me in the chest and have a big beam sticking out
of it
S yeah that would be good
S You said something about being able to put other people’s cushions on here not
necessarily use these. You weren’t necessarily designing the cushions you were designing
the frame more
C right
S I like how all your cushions come off easy. I think that if it’s too difficult than they don’t
take them off and clean them
S yeah but if it’s too easy then they get lost
S that’s true
S I was thinking that if there was some kind of snap like with those side pieces. If they
came down and snapped onto the frame it would be a little bit harder to get off but it
would still be easy enough to wash

96
S I noticed that these were all velcroed together which might help keep them from getting
lost. Something that makes it easy to get off but also something that makes it stay on.
S seat cushion usually that’s not too much of a problem, but the side things. I’m thinking of
one in particular. His feet never stop. That cover would be off in two seconds. Yeah he’s
got some athetosis and he just never stops moving. That cover would be gone and we’d
be like, where’d it go?
S so this is really for height?
C yeah this is so you can adjust the height and you can remove this panel if you had a
toddler size and then just use the top panel, slide it all the way down and in
S so it’s still just one cover
C yeah the cover you’d have to buy one for the specific size of kid
S seatbelts?
C I didn’t design that into it but it’s on all other chairs so it should be.
S so do you think? We have a lot of kids with extreme tone, more involved, a lot of times.
I’m just kind of wondering about the whole frame.
C yeah I just put this on with one bolt on to make it easy for you guys to adjust
S let me give you an example, like the footplates in particular we have kids that are just
really strong and can stand and these footplates they get bent and oftentimes we just have
to continually replace them and there’s a little adjustment where the screw comes out and
pops the plate angle up a little bit… I’m just kind of wondering about the general
thickness or something.
S yeah like in this back here. Some of them are pretty powerful there
C this would need to be tested
S what kind of material is this?
C this is aluminum
S Which makes it lighter weight.
C maybe the seat back needs to be made out of this thickness here, like the footplates
S was this also designed to be able to make it a wider headrest or is this bar just for
strength?
C just for strength

97
S all the pressure’s going to be up here, this might need to be stronger (referring to length
of lever arm on headrest)
inaudible
S I was just thinking that sometimes the kids will get their arms kinda out and around and
oftentimes the laterals will kinda get their hands caught or their arm will dig into the
lateral. If the upholstery maybe wrapped around more.
S the headrest too and this is well as this because even though this has padding on this side
they’ll push down on top of this and that will really dig in
S will there be an option to put a tray on?
C yeah, I didn’t make one, but I put some slots here and with some different upholstery it is
something that I think it’s something important to have or maybe an arm pad.
S If you put a cushion would the height change? (pointing to side supports)
C yeah that would probably need to. I was thinking that this could be a receptacle for a
different kind of armrest as well if you needed a different arm rest height there
S yeah that’s true
S and how many pounds did you say?
C well this one hasn’t been tested but this one would be up to 100 pounds
S I mean the weight of it to take it apart,
C the total weight of the chair? This model is 28 lbs. a lot of that is, these are really solid
injection molded parts, and if these were injection molded then it could be lighter weight
S have you ever tried to put it in a trunk?
C I have put it in my trunk but I do have a hatchback
P I don’t think that would fit in my mom’s car, she actually has to take her’s apart to fit in
her car and I don’t think that would fit in my mom’s car, that’s what we always look at
when we look at chairs
P I bought my care purely because this fit in the trunk
P I drive a pacifica without the 3rd row seat so that I don’t have to take this apart and I can
just put it in. It’s a convenience thing to not have to take the wheels off.
P and you said you can put big wheels on the back if they want to self propel

98
C Yeah although I think probably a kid who self-propels wouldn’t need tilt-in-space seating
but at least that’s what we got out of the last focus group but the idea is that you could
take some of the same components and build different chairs out of them
S that’s the whole point of having a modular chair
S so is this meant to come all the way back here (pointing to backrest)
C yeah it can go all the way back
S It’s like a really cool recumbent bike
S there’s no adjustability in the angle of these foot rests?
C plantar dorsiflexion? No
Inaudible
S this folds extremely flat
S like a regular stroller?
S about 28 inches. It’s not all the way up but… (measuring from seat back to footplate with
leg rests up)
S I like the knobs because you can twist them. I like the actual shape
S the knobs need to be attached to the bolt
C I could use a captive screw so that it wouldn’t get lost. Do you think it would be useful to
have a push button quick release at those points where I have a knob?
S how gummed up do they get with like syrup?
C maybe we should do that in testing? Pour syrup on them
S some of the tube feeding formulas and things like that
S also how much force can those take, because for the footplates, they’re going to put a lot
of force on those.
S sometimes when you try to break the screws loose you can’t because it’s crusted with
food
S I have a regular stroller that has these things and when I went up over a curb it cracked
C really? Where?
S right in here (at the joint) and my daughter is 30 lbs
C that’s kind of upsetting because I took these off another pediatric wheelchair

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S this was a regular stroller so I don’t know but it is the same sort of thing. I had it in a
wheelie going up a curb. The company told me that it’s not meant for curbs, but that’s
what you have to do.
S Do you think this chair could get enough weight to actually tip backward?
C you mean, does it need anti-tippers?
S yeah, there are not tippers and I was just kind of wondering
inaudible
C If you guys feel you’ve gotten enough of a feel for the chair, then you can work on filling
out the questionnaire
S Is there also a way that you could color code the adjustments? Like height, because there
are so many different holes there. Like if you had all reds for this height range to make it
easier for those of us who making the adjustment.
Inaudible
S Even our most dependent kids still stand sometimes and I was just thinking about how to
get the leg rests away I mean
S well she pushed it back all the way to do transfers but I don’t know if those footrests, but
she said they adjust independently height wise, could they swing away that way? Like
could you make a release so that whenever you flip them up they could swing out to the
side
C I didn’t put a lot of thought into it, I can show you how the height adjusts though.
S Is there a plate underneath there to hold them together?
C yeah (shows foot plate height adjustment)
S oh ok, but once those are set at a height then they can’t do that
C I’m thinking though that if it were a quick release then you could have that
But would the bar be in the way?
S no because if you tilted it all the way up (anterior tilt). Oh but then the wheels would be
in the way
S could the footplates swing inside? Underneath the chair? The wheels would be in the way
then
C yeah, we could do that.

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S yeah because what happens when you get the kid and everything’s ready and then you
realize you’re still 4 inches away from the toilet? And then the casters
C so you guys are saying that it would be best if the footplates swing away
S well most of the kids we see do some sort of stand for a short…
S well, it’s something we encourage so that when they’re adults they can at least stand
enough to help with transfers
S so if it could swing away enough to allow for a standing pivot transfer
S well and this chair is low. I think a lot of the tilt chairs are really high therefore a lift
transfer or a 2 person transfer is because it’s high. But if it’s low then it’s actually
beneficial for the kid to do a stand. This wouldn’t be as good for a caregiver if they’re
actually picking up so I guess it depends on what kind of person you want to
S unless you could make it like a barber chair
C do you have any chairs like that
S no only the power ones, they can even take them to a standing position
S I always thought a chair should be able to somehow ramp down. If you had some type of
mechanism that could do that. Not necessarily power
C like the permobil that gets down to the floor?
S what do you mean like the seat comes forward so that can sit in it and then comes back?
S I mean so that whenever they need to transfer the seat could glide down so their feet
could touch the ground and help with transfers then it would slide back again and bring
them to a normal working height
S aren’t there feeder seats like that? With a hydraulic? I think it’s marketed as a feeder or
functional seat where it can go to floor height to transfer out of or at table height to be up
with peers. Is that the tiger?
S yeah, the one with the seat that goes on different bases. A stroller base and then a hi/low
base. Peer height, table height
S it’s not a mobility device, but I think there’s a lot of funding issues with it because they
say you know you can eat in your wheelchair
P Hannah uses her wheelchair herself and we encourage that, but for me to push her myself
to go walking. It’s not comfortable. If she could have the best of both worlds and then I
would love it. Like we went to Europe last year and to push that through Europe was just

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 absolutely awful (referring to canes on small manual pushrim chair). And look how high
it is how can I be comfortable like that, where as that is more like a jogging stroller and it
would be more comfortable and I like that aspect of it. I think you’d be able to market
that to both self-propel and attendant
C or maybe make a push handle that could fit on a small manual wheelchair
P yeah, but she;s had a little manual chair since she was 2 years old and the other one had a
big stick that stuck out. Yeah, it was a quickie…
I do like that feature of it and now that it’s all upright, if you put wheels on that she could
propel that herself
S It does seem like it is slanted lower. So that the front is lower. Not a perfect 90 which is
helpful for a transfer, but the wheels and the footplates are a bit of a
C the casters being out in front are a problem for transfers?
S actually the side apart is nice because somebody could get in
S I’m thinking I don’t know about a toilet but for a chair you could get the leg between the
footplate and the caster, but then the footplates have gotta be able to come off.
P you’re talking about transfer where your kids can stand up or even partially. Where I
think about transfer I think of sliding because she can’t stand on her feet at all. She has to
go to side
S so she’d have to get those laterals off
P she needs the laterals for her back
P I like that it tilts forward, because for her that would help her to become more
independent. You have to think of that even though you were looking for a very involved
child. A lot of that stuff will help you know someone like my daughter to become more
independent
S it is frustrating, I think the main frustrating thing about the tilts is that because they’re so
high you can’t teach any functional things because they’re so high off the ground
S I really like this chair compared to the other one, the fabric is much lighter, the design is
cool. I like it (participated in 1st focus group)
S could that frame be made so that it collapsed more so that it could fit into a trunk
C so that it was narrower?
S how low does it go? Can you shrink that?

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S I’m actually thinking of bringing the wheels closer laterally, those two bars on the sides,
could they collapse somehow?
S well that makes the base more fragile right?
S right, but if there’s a way that you could make it unlocks but when it locks back down it’s
reinforced
C It’s possible
S We have two moms here who both express that it’s a big factor
P and I’m lazy just keep that in mind. I buy cars and suvs so that I don’t need to take things
apart
C so what you’re saying is that if the overall width could somehow collapse
S I was wondering, when it’s all collapsed down, how tall is it
C do you guys have any experience with quick release casters. I thought that maybe the
caster could be quick release and if the casters came off and the wheels came off then the
overall height would be shorter
S as long as that center doesn’t collapse down anymore then quick release casters would be
a pretty good option. Like this chair, the casters are quick release, it’s not actually quick
but it does release. If I have someone else’s car, that’s an option I sometimes use.
C Does it need a tool?
S no, it’s just this screw and then it comes down, it’s still a pain and it takes me 20 min to
remember how to put it back on
S Have you put that in a trunk?
C I do put it in my trunk, but I have a hatchback.
S I’m wondering if you actually put it in a pop-up trunk
C I haven’t
S I think if you made more moveable parts in that frame, I think that would not be a good
idea. Because how would you do that? You’d have to make it fold.
S that adds weight
S and those folding tilts often times there’s so much movement in them that they’re
assymetrical. Are all of them on cables that tilt?
C all the ones that I’ve seen, the manual tilting

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S I guess you’d have to have that. I guess that I always think as soon as you put moving
parts
C so are you saying that because of the tweaking that happens in the cross frame,
sometimes the tilt mechanism isn’t very smooth anymore?
S yeah, all of a sudden they’re no longer in alignment
S you might not get that with a footplate that’s attached or with this design. I don’t know.
But I know that’s something parents don’t like with the folding tilts and they get it
because they think they’re going to break it down, fold it and put it in a car, but they
never use it like that, because it’s too hard to figure out how to get it back symmetrically
and then what happens is the seat doesn’t go on right and that’s why they come in and the
whole seat’s not attached to the frame or like one tilt is up and one tilt is back and the
footplates are kinda like this and so I don’t like it
S and then there’s cables that get corroded and it either locks into like falling or dropping
backward
S could those red bars be some type of quick release that it falls on top of it, know what I
mean?
C that would allow this to come down
P I think you need to make it more flat to fit into a trunk then you’d have to see how the
seat would fit in. I guess you’d have to put it on it’s side on top of it.
S The seat you could almost put in a seat with a seat belt
S also if you could make it so it could work as a car seat too. That would be awesome
C yeah, further down the road. This needs more design, but the idea is that it could be used
as a car seat. This isn’t crashworthy though
S I do think it would be interesting if the casters could come off because we’re always…
front casters are cumbersome for 2 reasons. 1, if you’re transferring against something
but also getting the leg rests out of the way
Inaudible
S One of the questions is, it’s easy to switch from attendant wheels to pushrim wheels, can
you do that now? Is that one of the quick release options
C it’s not really applicable to this questionnaire, because we didn’t do it in the focus group,
but if you unscrew this bracket, and put it here then you can put on a 20” wheel.

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Measure focus group participant (child’s) wheelchair
P So you’d be able to take any standard wheel and put them on there?
C I also thought this would be useful for a power assist wheel
P we have those at home too. They’re hard. You ever try those? She did a 360 at the mall
one day trying to use them
S it must just be a learning curve though
P oh yeah, it’s a huge learning curve
S you can turn them down
P also, she uses one side to propel more than the other so she…
S You can also make one the sensitive one and the other harder for the strong arm
P We take her for practice every once in a while. When we got the new wheelchair we got
power assist, because they wanted to put her in a power chair and I didn’t want to put her
in a power chair, but the gentleman was saying she’s going to rip her rotator cuffs and all
those things, so I agreed to and met them half way and agreed to power assist wheels. My
whole thing was that I wanted her to keep propelling
inaudible
S These adjustments are the kinds of things that are going to happen when you first put the
kid in there, once the kid is in there, they’re going to happen less often, so it wouldn’t
take as long. I’m thinking if you can start with the kid in one plane and then it can grow
with them, it could technically last a very long time. Either that or you have multiple
parts which increases the cost, I guess so. It’s kind of a pain to do it the first time,
because you’ve got all these pieces, but once you get it in there til they grow enough.
Yeah I don’t think it’s too much of a hassle.
S So if you had the pushrim wheels, they’d fit into that hole. You just don’t have them in
there now.
C So this comes off like this (demonstrating removing wheel)
S oh ok. So if someone was going to go from one to the other, they would have two of
those brackets in there. I’m thinking if it was a family and they were going to switch
them, they would need to have two at what ever setting they would need to have it, so
they could just switch the wheel easily.
S now if you’re going to want to put 22” you’re going to have another adjustment,

105
C yeah, because this is for 20”. These holes would need to be one inch higher up for 22”
wheels
S so this is designed specifically for a 20” wheel
S for some reason, the 20” wheels are hard to push. I think the 22 just makes everything
easier
P and I agree, someone mentioned a seatbelt, you’re gonna need a seatbelt especially when
kids are propelling themselves because even when she’s not moving she’s freaked out if
she’s not strapped in and her little chair she’s rolled out before too, so and I think if
they’re gonna propel you need to tippers too
S I don’t know why but in our school we have tons of kids in tilt mechanisms with those
mechlocks that are constantly broken. We do a monthly wheelchair clinic and they’re
constantly broken.
C really? Do you know where? The cable breaks?
S I’m not sure which part of the mechanism actually breaks. That’s a good question I could
ask, but both the hub locks and the mechlocks. Because most kids now have the brakes
that have cables. I don’t know where it is
C It’s probably in the cable I would think but that’s a good question
S the cables getting pulled or abused somehow
S if it’s broken, it takes a while to get the part. What we do is we use those plastic zip ties
and we cinch the chair down in one angle because they can’t use the handles. I always
thought it’d be good to have an extra cable with the chair. The guys that repair them do
know.
P you ask a money question in here. I wouldn’t know how much to pay for a wheelchair
because you know in Pennsylvania we have the two insurances so I wouldn’t know what
to circle because my double insurances will cover it. I haven’t paid out of pocket for any
of them
P If it’s under 800$ insurance isn’t going to cover it anyhow. Hers just barely made the
limit. They almost didn’t pay for it because it didn’t cost enough
S it’s ridiculous because other things they won’t pay for, because they cost too much
P we had to get a couple extras so that they’d cover it

106
C Is adjustable upholstery something that you think would be beneficial or something that
you’ve seen with chairs?
S no.
S I’m wondering adjustable upholstery?
S I personally think that when you grow a chair, the upholstery’s going to be done and
you’re gonna need a new piece.
C yeah, I guess it will get worn out
S yeah it really does
S I have a concern about losing those pieces (the upholstery)
S I think snaps are a good idea. Snaps that snap to the frame
S there are some chairs I’d love to clean
S we power wash some kids chairs. We take them out and power wash them in the morning
and dry them all day long
S some of those upholsteries don’t come off and they get dirty!
P I don’t even know how her seat would come off, I’m not educated on my daughter’s chair
unfortunately. There are times though where she has spilled ice cream
P I’m telling you though, I’d love to have a handle like that to push
S Oh yeah
P just to go walking and things like that it would just be
S I think a lot of parents think that and I think that’s what we… wasn’t that one of the big
feedbacks last time, a handle that was adjustable and you could just adjust like a stroller
S What about the tippers. That’s a disadvantage of those tippers, when you step to tilt it
back, you kill your toes
S yeah, lots of parents take them off and then you can’t get them up on a curb either. It’s
not really functional but then when you’re self-propelling you need it
S we do have lots of kids with tone who, they’re not propelling but the chair’s moving.
S yeah, their center of gravity is constantly changing
S we just tested this out and we like this a lot. How close you can get to a chair.
S how about a toilet
S as long as we can get the footplates up and out of the way, then we can slide this in and
right next to the chair. I’ll use this chair as an example

107
P or if the footplates were reinforced enough that they could transfer on them because it’s
only reinforced up to 100 lbs. I think it’s long enough that if you stood on it, the chair
would be counterbalanced and not tip forward
S So, depending on if you would want to make it strong enough for that. But as we were
saying, if the footplates came up and out of the way for transfers, it’d be really nice.
P or if the footplates were strong enough, she could get up off the floor, she could bump up
onto the footplates and then bump up onto the chair.
P that’s why it’s nice that you have the anterior tilt. I think you should make it for both
kinds of kids in mind, because there are lots of features that I like that I would look into
getting
S It’s nice that it’s a low chair and that’s a very good thing
S yeah they’re usually so high. They’re focused on the caregiver’s back
P we had a little quickie that was lower. The reason we got the higher chair was so that she
could be eye level with her peers and still propel. I like the tilt (anterior) because I could
teach her to be independent. I could tilt it and then say, so how are you going to get out of
the chair?
P It’s also good if you’re out in the community and you need to do some hygiene things
she’s laying back. With no facilities, that’s kind of nice.
P well I have that problem, because she’s now to old to take her into the baby changing
room, so now we’re going into the handicapped bathroom and I end up laying her down
on the floor in order to do what I need to do.
S so, a tilt-in-space would be nice because then you could do that in the tilt in space and get
her up off the floor
S also though if you tilt a child who doesn’t have enough trunk control. I don’t think I’ve
ever transferred somebody with an anterior tilt like that, have you?
S I can’t think of any place where we’d have the ability to. I don’t know of anychair that
does that. The low part’s good, but it is tilted forward, that’s really far forward.
S but is that something that could be if needed locked so it couldn’t go beyond that certain
point is that what you’re talking about?
S no, I’m just talking about that anterior tilt, I’ve just never done it

108
C the idea is, I didn’t think about the anterior tilt being good for an independent transfer. I
thought maybe that would help the caregiver, bringing the kid forward but it’s interesting
that you bring that up. It’s something I never thought of, for a standing pivot transfer.
S It does make it easier to transfer out
S It also helps with gravity even just to push their hips forward if they could even just do
that tiny bit
C that’s another thing, some people said earlier that in school, a little anterior tilt can help a
kid to lean closer to the table was a good thing
S yeah that’s good too
C so if you have any more thought? Otherwise, I thank you for your feedback
S I’m kind of curious how a seat belt would anchor.
C I think maybe to the frame
S we have a 4 point lap belt, but I don’t know how you’d anchor it with the handle the way
they are now
S never attach it to the backrest. It has to adjust with them too, as you adjust the chair.

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APPENDIX C. CAD DRAWINGS

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Table 12: Parts spreadsheet for Final PALM prototype

Sub- part Part name # source prototype protoype prototyping drawing

assembly # parts Material stock/ process
name hardware
specs
Backrest
a1 backrest 2 HERL 6061 al 0.125" sheet CNC mill, bend x
attachment bracket
a2 backrest bottom 1 HERL 6061 al 0.0625" sheet CNC mill, bend x
panel left
backrest bottom 1 HERL 6061 al 0.0625" sheet CNC mill, bend mirror
panel right
a3 backrest center 1 HERL 6061 al 0.125" sheet CNC mill, bend x
panel
a4 backrest pivot joint 4 HERL SLA resin SLA x
a5 backrest top panel 1 HERL 6061 al 0.0625" sheet CNC mill, bend x
right
backrest top panel 1 HERL 6061 al 0.0625" sheet CNC mill, bend mirror
left
a6 headrest bracket 1 HERL 6061 al 0.0625" sheet CNC mill, bend x
left
headrest bracket 1 HERL 6061 al 0.0625" sheet CNC mill, bend mirror
left
a7 headrest plate 1 HERL 6061 al 0.0625" sheet CNC mill, bend x
a8 headrest spacer 1 HERL delrin x
a9 knob 4 HERL plastic SLA resin SLA x
a10 lateral trunk 2 HERL 6061 al 0.0625" sheet CNC mill, bend x
support

Seat
b1 footrest attachment 1 HERL SLA resin SLA x
bracket right
footrest attachment 1 SLA resin SLA mirror
bracket left
b2 front cross tube 1 HERL 6061 al 0.75" OD cut, drill x
0.060" WT

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 tube
a9 knob 4 HERL plastic SLA resin SLA x
b3 seat bottom plate 1 HERL 6061 al 0.0625" sheet CNC mill, x
bend, manual
mill
b4 seat pan tube 2 HERL 6061 al 1" OD 0.060" cut, drill x
WT tube
b5 side support left 1 HERL 6061 al 0.125" sheet CNC mill, bend x
side support right 2 HERL 6061 al 0.125" sheet CNC mill, bend mirror
b6 0.75" tube plug 2 HERL 6061 al al rod turn, drill, tap x

Seat clamp
c1 bottom clamp 2 HERL 6061 al bar stock edm, mill, x
ream, tap
c2 clamp pivot block 2 HERL 6061 al bar stock mill, drill, tap x
a9 knob 2 HERL SLA resin SLA x
c3 top clamp 2 HERL 6061 al bar stock edm, mill, x
ream, tap

Footrest
d1 footplate right 1 HERL 6061 al 0.125" sheet CNC mill, bend x
footplate left 1 HERL 6061 al 0.125" sheet CNC mill, bend mirror
d2 footplate bracket 1 HERL SLA resin SLA x
right
footplate bracket 1 HERL SLA resin SLA mirror
left
d3 footrest pivot joint 2 HERL SLA resin SLA x
d4 footrest tube 1 HERL 6061 al 0.75" OD cut, bend, drill x
0.060" WT
tube

Top Frame
e1 0.875" end cap 2 HERL SLA resin SLA x
e2 0.875" tube plug 2 HERL 6061 al al rod turn, drill, tap x
e3 1" top frame tube 4 HERL 6061 al al rod turn, drill, tap x
plug
e4 push handle 2 HERL 6061 al 0.875" OD bend, drill x
bottom tube 0.60 WT tube

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 e5 push handle 2 HERL SLA resin SLA x
bracket
e6 push handle clamp 4 HERL 6061 al bar stock EDM, drill, tap x
mechlok bracket 1 OEM
e7 seat tube plug 2 HERL delrin rod turn, drill x
e8 screw cap 4 HERL SLA resin SLA x
e9 top frame bracket 4 HERL SLA resin SLA x
e10 top frame front 1 HERL 6061 al 1" OD 0.060" cut, drill x
cross tube WT tube
e11 top frame rear 1 HERL 6061 al 1" OD 0.060" cut, drill x
cross tube WT tube
e12 top frame side tube 2 HERL 6061 al 1" OD 0.060" cut, drill x
WT tube

Linkage arms
f1 front linkage arm 2 HERL 6061 al 0.75" OD cut, drill x
0.060" WT
tube
f2 rear linkage arm 2 HERL 6061 al 0.75" OD cut, drill x
0.060" WT
tube
f3 pivot arm joint 8 HERL SLA resin SLA x
b6 0.75" tube plug 8 HERL 6061 al rod turn, drill, tap x

Mechlok
assembly
g1 0.75" end cap 1 HERL SLA resin SLA x
b6 0.75" tube plug 1 HERL 6061 al rod turn, drill, tap x
mechlok 1 OEM
g2 mechlok clamp 2 HERL 6061 al bar stock EDM, drill, tap x
g3 mechlok joint 1 HERL SLA resin SLA x
g4 mechlok tube 1 HERL 6061 al 0.75" OD 0.60 bend, drill x
WT tube

Push handle
e2 0.875" tube plug 2 HERL 6061 al rod turn, drill, tap x
a9 knob 4 HERL SLA resin SLA x
push handle 2 OEM

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 adjustment bracket
h1 push handle brace 2 HERL SLA resin SLA x
bracket
h2 push handle brace 1 HERL 6061 al 0.5" OD 0.60 cut, drill x
tube WT tube
e5 push handle 2 HERL SLA resin SLA x
bracket
push handle grip 2 OEM
h3 push handle side 2 HERL 6061 al 0.875" OD cut, drill x
tube 0.60 WT tube
h4 push handle tube 1 HERL 6061 al 0.875" OD cut, drill x
0.60 WT tube
locking handle 2 OEM
locking handle 2 OEM
bracket
e8 screw cap 2 HERL SLA resin SLA x

Bottom
Frame
i1 1.0 tube plug 4 HERL 6061 al rod turn, drill, tap x
i2 axle insert 2 HERL mild steel rod turn, thread, x
mill
i3 bottom frame front 1 HERL 6061 al 1" OD 0.060" cut, drill x
tube WT tube
i4 bottom frame side 2 HERL 6061 al 1" OD 0.060" cut, drill, bend x
tube WT tube
i0 caster assembly 2 OEM x
i5 caster end cap 2 HERL SLA resin SLA x
i6 caster stem spacer 2 HERL 6061 al rod turn, drill, mill x
i7 caster tube plug 2 HERL 6061 al rod turn, drill, tap x
i8 front inside spacer 2 HERL 6061 al 1.25" OD cut x
0.035" WT
tube
i9 front outside 2 HERL 6061 al 1.25" OD cut x
spacer 0.035" WT
tube
i10 front plastic joint 1 HERL SLA resin SLA x
left

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 front plastic joint 1 HERL SLA resin SLA mirror
right
i11 rear inside spacer 1 HERL 6061 al 1.25" OD cut x
0.035" WT
tube
i12 rear joint end cap 2 HERL SLA resin SLA x
i13 rear outside spacer 2 HERL 6061 al 1.25" OD cut x
0.035" WT
tube
i14 rear plastic joint 2 HERL SLA resin SLA x
i15 rear wheel 2 OEM x
i16 wheel axle 2 OEM x

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